SickKids doctors implant the first total artificial heart for a child in Canada
Last year, when Mariam Tannous’ first heart transplant started failing and other medical interventions were no longer working, her clinical team at The Hospital for Sick Children (SickKids) had to quickly think outside the box for an innovative treatment. With time ticking away and an urgent need to bridge Mariam to a second heart transplant, the team decided to try something that had never been done before at SickKids or in Canada – a total artificial heart implant for a paediatric patient.
Mariam’s team at SickKids consulted with colleagues in the United States and received training on the technology, and within two weeks, 11-year-old Mariam became the first paediatric patient in Canada to receive a total artificial heart. She was also one of the smallest patients, and youngest, in the world to have the device implanted.
Finding an urgent solution to Mariam’s failing heart transplant
Mariam, now 12, was born with two forms of congenital heart disease, Epstein’s Anomaly and cardiomyopathy, which meant her right heart ventricle was not well-formed and the valve was leaking. In 2017, she successfully underwent her first heart transplant at SickKids, and was able to go home and resume her favourite activities like swimming and soccer.
A few years later, Mariam unexpectedly started to go into heart failure again and was admitted to SickKids. Her doctors tried various heart failure medications but Mariam’s condition only got worse. She would need a second transplant and the clinical team had to buy her time until a heart became available. As both ventricles of Mariam’s transplanted heart were showing signs of failure, the only option was a total artificial heart – device that can effectively replace an entire human heart for a limited period of time to help bridge patients to a transplant.
Mariam relearning how to walk and move while attached to the total artificial heart.
“Total artificial hearts are rarely used in paediatric patients due to their size and limitations,” explains Mariam’s cardiologist, Dr. Aamir Jeewa, Medical Director of the Ventricular Assist Device Program at SickKids. “The device, intended for larger adults, has a large set of mechanical pumps that are surgically connected to vessels inside the chest and are driven by connections, outside of the body, to a large controller unit that is almost as tall as Mariam herself and runs 24 hours a day.”
The total artificial heart would provide Mariam with time until she could receive a second transplant, but she could not be connected to the device indefinitely. A number of factors such as potential infection risks, device failure and other health complications make the device a time-limited option, especially for a young person like Mariam.
Since this was a first-of-its-kind procedure at SickKids, Mariam’s parents had a difficult decision to make. “We had a meeting and they told us about the total artificial heart. They explained to us all the risks and what would happen in the surgery and after,” says Linda Antouan Adwar, Mariam’s mom.
SickKids team embarks on innovative surgical procedure
Jeewa and Dr. Osami Honjo, Mariam’s cardiovascular surgeon, Surgical Director of Heart Transplantation and Mechanical Circulatory Support and Watson Family Chair in Cardiovascular Sciences at SickKids, quickly started to collaborate with American colleagues to train SickKids staff on the device, the surgical procedure and post-surgical care.
“Although we often manage other types of assistive devices, everything about the total artificial heart was new for the team. The fact that Mariam was one of the smallest patients in the world to have this device also presented a significant technical challenge,” explains Honjo.
On July 8, 2021, the surgery was successfully completed and Mariam began her recovery. With the support of her multidisciplinary team, she had to relearn how to walk, drink and eat while being attached to a large machine and tubes that kept her artificial heart pumping.
“Mariam always needs to do everything fast, and sometimes she would forget she has the machine attached to her. I would have to tell her ‘Wait, slow down, you have a machine with you’ and she just wanted to go,” recalls Linda.
A couple months later, Mariam received her second heart transplant and third surgery with Honjo. He says, “Mariam and her family have gone through a lot and it’s been my honour to join them on this journey. I’m so happy to see her thrive and go back to her life once again. It’s fantastic.”
While Mariam still faces ongoing challenges with her health, she is enjoying being at home, playing with her brother and returning to school with her friends. “I’m so happy and we are so proud of her,” says Linda. “Her journey is not easy, but day by day she shows us how strong she is now.”
Left: Mariam attending school after receiving her second heart transplant.
Right: Mariam today.