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2<br />

Both failing<br />

ventricles<br />

are removed.<br />

The four<br />

native valves<br />

are removed.<br />

The atria, aorta<br />

and pulmonary<br />

artery remain<br />

intact.<br />

Quick connects are<br />

sewn into the atria,<br />

aorta and pulmonary<br />

artery.<br />

The Total Artificial<br />

Heart (TAH) is implanted<br />

and attached via four<br />

quick connects.<br />

When a donor heart<br />

becomes available,<br />

the TAH and quick<br />

connects are<br />

removed.<br />

The donor<br />

heart is<br />

transplanted.<br />

For patients dying from end-stage biventricular<br />

heart failure, there are only two options:<br />

1. An immediate donor heart transplant, availability uncertain.<br />

2. The <strong>SynCardia</strong> temporary Total Artificial Heart as a bridge to transplant,<br />

Donor Hearts: Only 3,500 Available Worldwide Annually<br />

# of Donor Heart Transplants<br />

immediately available at <strong>SynCardia</strong> Certified Centers.<br />

2500 –<br />

2000 –<br />

1500 –<br />

1000 –<br />

500 –<br />

US Donor Heart Transplants<br />

0 – 90 95 00 05 10<br />

Year<br />

Despite growing demand worldwide, only 3,500 donor hearts become available annually.<br />

It is estimated that each year, up to 100,000 people in the U.S. alone could benefit<br />

from mechanical circulatory support devices such as the <strong>SynCardia</strong> Total Artificial Heart.<br />

<strong>SynCardia</strong> Total Artificial Heart<br />

Originally used as a permanent replacement heart, the Total Artificial Heart is currently<br />

approved as a bridge to transplant for transplant-eligible patients at risk of imminent<br />

death from biventricular failure. It is the world’s first and only FDA, Health Canada and<br />

CE approved Total Artificial Heart.<br />

Bridge to Second Transplant<br />

The <strong>SynCardia</strong> Total Artificial<br />

Heart is the only device that<br />

allows surgeons to remove the<br />

failing transplanted heart and<br />

stop immunosuppressant<br />

medication until a second<br />

matching donor heart can be<br />

transplanted.<br />

“I have witnessed several patients who needed a second transplantation,<br />

but died before a donor heart became available. Those patients would<br />

have been excellent candidates for an immediately-available heart.<br />

The Total Artificial Heart is the only device that allows us to remove the<br />

failing donor heart completely and bridge patients to a second transplant<br />

without immunosuppressive therapy.”<br />

David Luís Simón Morales, MD<br />

Executive Co-Director, The Heart Institute<br />

Professor and Endowed Chair of Pediatric Cardiothoracic Surgery<br />

Chief, Pediatric Cardiothoracic Surgery<br />

Cincinnati Children’s Hospital Medical Center<br />

The University of Cincinnati College of Medicine<br />

Survival (%)<br />

100<br />

80<br />

60<br />

40<br />

20<br />

Survival Curve After Heart Transplantation<br />

N = 66,751<br />

# of Donor Heart Transplants<br />

Europe Donor Heart Transplants<br />

2500 –<br />

2000 –<br />

1500 –<br />

1000 –<br />

500 –<br />

0 – 01 02 03 04 05 06 07 08<br />

Year<br />

0<br />

Years 0 4 8 12 16 21<br />

Source: Journal of the American College of Surgery 2006; 203(2): 226-39.


Human Heart<br />

Similar to a heart transplant, the <strong>SynCardia</strong> Total Artificial Heart<br />

is the only device that:<br />

Eliminates the symptoms & source of end-stage biventricular heart failure<br />

Replaces both failing ventricles<br />

Replaces all four heart valves<br />

Eliminates native heart complications<br />

No ventricle dysfunction/failure<br />

No diseased heart valves<br />

No arrhythmias or need for pacemaker/defibrillator<br />

Provides immediate, safe blood flow up to 9.5 L/min through each ventricle<br />

Immediately restores normal Cardiac Index (CI)<br />

Immediately restores normal Central Venous Pressure (CVP)<br />

Overcomes high Pulmonary Arterial Pressure (PAP)<br />

Restores normal hemodynamics and organ perfusion<br />

Unlike a donor heart, the <strong>SynCardia</strong> Total Artificial Heart<br />

Is immediately available at <strong>SynCardia</strong> Certified Centers<br />

Does not require expensive, immunosuppressant medication, which can cause subsequent complications<br />

Mr. Okeke received his first heart transplant at age 30 after a blood clot damaged<br />

his coronary artery. Thirteen years later, his body began rejecting his donor heart and he was<br />

implanted with the Total Artificial Heart. Since receiving his second heart transplant in January 2011,<br />

Mr. Okeke has been enjoying life at home with his wife Natalie and their three young children.<br />

Charles Okeke UNITED STATES<br />

<strong>SynCardia</strong> temporary<br />

Total Artificial Heart<br />

Implanted: Sept. 3, 2008<br />

Freedom® discharge: May 3, 2010<br />

Transplanted: Jan. 15, 2011<br />

CAUTION - The Freedom® portable driver is an investigational device, limited by United States law to investigational use.<br />

3


Patients Recover Rapidly with the <strong>SynCardia</strong> Total Artificial Heart<br />

Safe Blood Flow Up to 9.5 Liters per Minute<br />

The Total Artificial Heart is the only device that provides immediate,<br />

laminar blood flow of up to 9.5 liters per minute through each ventricle.<br />

Implanting the Total Artificial Heart helps<br />

make patients healthier transplant candidates:<br />

n Immediately increases Cardiac Index (CI)<br />

n Immediately restores normal Central Venous Pressure (CVP)<br />

n Resuscitates kidneys, liver, GI tract, brain, other vital organs<br />

n Overcomes high Pulmonary Arterial Pressure (PAP)<br />

n Restores normal hemodynamics and organ perfusion<br />

Data from the 10-year pivotal clinical study of the Total Artificial Heart, published in the New England Journal of Medicine<br />

(N Engl J Med 2004; 351:859-867)<br />

Immediate <strong>Inc</strong>rease in Cardiac Index Organ Recovery at Two Weeks<br />

Prior to implant, patients in need of the Total Artificial Heart had a<br />

baseline cardiac index of 1.9 L/min/m 2 .<br />

Immediately following implant, the patient’s cardiac index<br />

increased to an average of 2.9 L/min/m 2 .<br />

Liver function had returned to normal at two weeks<br />

Kidney function had improved significantly, trending to normal<br />

Physical Recovery Bridging the Sickest Patients to Transplant<br />

Post-Operative Day 5: Approximately 65% of the<br />

core Total Artificial Heart patients were out of bed.<br />

According to March 2011<br />

INTERMACS data,<br />

72% of Total Artificial<br />

Heart patients were<br />

transplanted at 6 months<br />

and 75% at 12 months.<br />

Post-Operative Day 14: 60% of core Total Artificial<br />

Heart patients were walking more than 100 feet.<br />

Previous reports have shown that<br />

almost all Total Artificial Heart patients<br />

were classified in the two sickest INTERMACS<br />

categories prior to implant, yet the <strong>SynCardia</strong><br />

Total Artificial Heart had the highest bridge to<br />

transplant rate of all the devices tracked in INTERMACS.<br />

French Total Artificial Heart<br />

patient Mr. Lediouron<br />

pictured at home with the<br />

Freedom® portable driver in<br />

Sept. 2010 with his wife<br />

Karene and their two<br />

daughters, Wendy<br />

and Sidney.<br />

In comparison, approximately 25% of patients with other<br />

mechanical circulatory support devices were classified in less<br />

sick categories prior to implant.<br />

Christian Lediouron<br />

FRANCE<br />

Implanted: May 17, 2010<br />

Freedom® discharge: June 30, 2010<br />

Transplanted: March 3, 2011<br />

Highest bridge to transplant rate: Survival to transplantation was<br />

achieved in 79% of patients who received the <strong>SynCardia</strong> Total Artificial<br />

Heart according to protocol, as compared with 46% of the controls who<br />

did not receive the device. This is the highest bridge to transplant rate of<br />

any approved heart device.<br />

Overall survival: The one-year survival rate among patients who received<br />

the Total Artificial Heart was 70%, as compared with 31% among the<br />

controls. One-year and five-year survival rates after transplantation<br />

among patients who had received the Total Artificial Heart were<br />

86% and 64%.<br />

4 5


The <strong>SynCardia</strong> Total Artificial Heart powered<br />

by the Freedom® portable driver<br />

Left ventricular assist device (LVAD)<br />

On July 22, 2011, Shawn Galloway became the first of four patients<br />

to receive the Total Artificial Heart at Texas Heart Institute during a 12-day period.<br />

A month after her surgery, she was discharged home to wait for a matching donor heart with<br />

her husband Joel and their daughter Hannah. She received her heart transplant on Sept. 20, 2011.<br />

Shawn Galloway UNITED STATES<br />

Implanted: July 22, 2011<br />

Freedom® discharge: Aug. 23, 2011<br />

Transplanted: Sept. 20, 2011<br />

CAUTION - The Freedom® portable driver is an investigational device, limited by United States law to investigational use.<br />

6<br />

Additional Benefits of the<br />

<strong>SynCardia</strong> Total Artificial Heart<br />

No right ventricular dysfunction/failure<br />

No acquired von Willebrand syndrome (AVWS) reported<br />

Right Ventricular Dysfunction/Failure after LVAD Implant<br />

HeartWare HVAD - ADVANCE Clinical Study Results<br />

22%<br />

of patients developed right heart failure requiring either a<br />

Right Ventricular Assist Device (RVAD) or inotropic support*<br />

HeartMate II LVAD - Pre-Market Approval Results<br />

19%<br />

of patients developed right heart failure during the<br />

pre-market approval of the HeartMate II**<br />

*Source: Evaluation of the HeartWare HVAD Left Ventricular Assist System for the Treatment of<br />

Advanced Heart Failure: Results of the ADVANCE Bridge to Transplant Trial; Keith Aaronson,<br />

Mark Slaughter, Edwin McGee, et al. for the HeartWare ADVANCE Investigators; American Heart<br />

Association Scientific Sessions November 2010<br />

**Source: HeartMate II FDA Summary of Safety and Effectiveness<br />

http://www.accessdata.fda.gov/cdrh_docs/pdf6/P060040b.pdf<br />

“Acquired von Willebrand syndrome in patients with<br />

ventricular assist device or total artificial heart”<br />

Authors: C. Heilmann, U. Geisen, F. Beyersdorf, L. Nakamura, C. Benk, M. Berchtold-Herz,<br />

G. Trummer, C. Schlensak, B. Zieger; University Medical Center Freiburg, Freiburg, Germany<br />

Published in Thrombosis and Haemostasis 2010 103 5: 962-967<br />

Summary:<br />

“Unexplained bleeding episodes are associated with ventricular assist devices (VAD) and can occur in part due to<br />

acquired von Willebrand syndrome (AVWS)… We studied 12 patients who required mechanical support of their<br />

native heart for terminal cardiac insufficiency. Nine patients underwent placement of a VAD, while three<br />

underwent placement of a total artificial heart (TAH)…<br />

AVWS was present within two weeks of implantation in eight of nine patients… AVWS was not observed in the<br />

TAH patients studied. Our findings demonstrate that patients with an implanted VAD experience a rapid onset<br />

of AVWS that is quickly and completely reversed after device explantation.”<br />

Prof. Dr. Friedhelm<br />

Beyersdorf, Director of<br />

Cardiovascular Surgery<br />

at University Medical<br />

Center Freiburg,<br />

Germany


First of 3<br />

consecutive pediatric<br />

patients bridged to transplant<br />

Jordan Merecka, 18, was the first pediatric <strong>SynCardia</strong> Total Artificial Heart patient to<br />

be discharged from Texas Children’s Hospital to wait for a matching donor heart at<br />

home using the Freedom® portable driver. Jordan, pictured with his mother Suzanne, received<br />

his donor heart transplant on Oct. 29, 2011, after 160 days of life with the Total Artificial Heart.<br />

<strong>SynCardia</strong> Drivers Power the Total Artificial Heart<br />

The Companion 2 “launch” driver powers the Total Artificial Heart in the hospital from the operating room implant until the patient’s<br />

condition stabilizes. Stable patients who are eligible are then switched to the Freedom® portable driver for in-hospital ambulation<br />

and home discharge*.<br />

Companion 2 Hospital Implant Driver<br />

CE approved for use in Europe<br />

FDA approved for use in the U.S.<br />

The Companion 2 driver can be docked in the Hospital Cart during patient recovery<br />

and the Caddy for in-hospital ambulation.<br />

Freedom® Portable Driver<br />

CE approved for discharge in Europe<br />

April 2012: Enrollment completed in FDA-approved<br />

Investigational Device Exemption (IDE) clinical study<br />

n World’s first wearable power supply for the Total Artificial Heart<br />

Design Features:<br />

n Runs on hospital air for quieter operation<br />

n Runs on internal compressors for improved mobility<br />

n Longer service life<br />

User-friendly touchscreen provides access to<br />

all driver functions… no keyboard required<br />

Three Operating Modes<br />

n Weighs 13.5 lbs ( ~6 kg) including two onboard rechargeable batteries<br />

n Designed to be carried by the patient in the Freedom Backpack or Shoulder Bag<br />

n Batteries are charged using a standard electrical outlet or<br />

car cigarette lighter adaptor<br />

*CAUTION – The Freedom® portable driver is an investigational device,<br />

limited by United States law to investigational use.<br />

Companion 2 and Freedom drivers are serviced by replacement<br />

n No on-site repair required<br />

n No inventory of parts required<br />

Jordan Merecka<br />

UNITED STATES<br />

Implanted: May 22, 2011<br />

Freedom® discharge: Aug. 31, 2011<br />

Transplanted: Oct. 29, 2011<br />

n Operating Room – all features and functions are available<br />

n Intensive Care Unit – full access to alarm modes and<br />

monitoring of critical functions<br />

n Ambulatory – heart rate & drive pressures need no adjustment<br />

The Freedom® portable driver with the<br />

<strong>SynCardia</strong> temporary Total Artificial Heart<br />

French Total<br />

Artificial Heart<br />

patient Mr. Amoussou,<br />

pictured in September 2010,<br />

carries his Freedom® portable<br />

driver in the Shoulder Bag.<br />

Antonio Amoussou FRANCE<br />

Implanted: Feb. 16, 2010<br />

Freedom® discharge: July 5, 2010<br />

Transplanted: Jan. 2, 2011<br />

7


30 Years of Proven Reliability<br />

Longest supported Total Artificial Heart patient, 1,374 days<br />

(nearly 4 years) prior to transplant<br />

1,000+ implants of the Total Artificial Heart account for more than 270 patient years of life<br />

The valves in the Total Artificial Heart have never failed<br />

The diaphragm has a failure rate of less than 1% over 2,000+ diaphragms<br />

<strong>SynCardia</strong> Products Under Development<br />

CAUTION - The Permanent Total Artificial Heart, 50cc Total Artificial Heart and Freedom® 2 prototypes are not for human use. These products<br />

are in the research and development phase and will not be ready for sale in the U.S. or Europe until after all regulatory requirements have been met.<br />

Permanent Total Artificial Heart<br />

n Intended for patients with a Body Surface Area (BSA) of 1.7m 2 or greater<br />

n On March 2, 2012, the FDA approved a Humanitarian Use Device (HUD) designation<br />

for the Total Artificial Heart to be used on a permanent basis.<br />

n <strong>SynCardia</strong> is currently working on submitting a Humanitarian Device<br />

Exemption (HDE) to the FDA.<br />

n Once approved, the HDE will allow up to 4,000 U.S. patients annually who are not<br />

transplant-eligible to receive the Total Artificial Heart on a permanent basis.<br />

New 50cc Total Artificial Heart<br />

n Intended for patients with a BSA of 1.2 to 1.7m 2<br />

n Designed for women, men of smaller stature and adolescents<br />

n Together, the 70cc and 50cc Total Artificial Hearts are designed to fit almost all<br />

adult men and women, and most adolescents.<br />

Freedom® 2 Portable Driver (In-hospital ambulation & home discharge)<br />

Intended Design Features:<br />

n Lighter and easier to carry<br />

n Quieter operation for improved quality of life<br />

n Longer service life<br />

For information about becoming a <strong>SynCardia</strong> Certified Center, contact:<br />

World’s Longest Supported Total Artificial Heart Patient<br />

Mr. Zorzetto, wearing the Freedom® portable driver in the Backpack, is the world’s longest supported<br />

Total Artificial Heart patient at 1,374 days. He received a matching donor heart after nearly 4 years of support.<br />

www.syncardia.com<br />

Pietro Zorzetto ITALY<br />

Implanted: Dec. 6, 2007<br />

Discharged: Feb. 4, 2008<br />

Transplanted: Sept. 9, 2011<br />

70cc <strong>SynCardia</strong> Total Artificial Heart<br />

50cc <strong>SynCardia</strong> Total Artificial Heart<br />

Freedom® 2 Portable Driver<br />

VP of Global Certification & Logistics Managing Directors<br />

Mary Pat Sloan +1 520 440-7593 | msloan@syncardia.com Dr. Oliver Voigt & Markus Leinberger | europe@syncardia.com<br />

1992 East Silverlake Rd. | Tucson, AZ 85713 +49 700 SYNCARDIA (796227342)

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