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J Am Coll Cardiol, 2002; 39:1764-1772 © 2002 by the American College of Cardiology Foundation |
* Department of Cardiovascular Surgery, University of Freiburg, Freiburg, Germany
Department of Cardiology, University of Freiburg, Freiburg, Germany
Manuscript received November 8, 2001; revised manuscript received February 26, 2002, accepted March 1, 2002.
* Reprint requests and correspondence: Dr. Michael P. Siegenthaler, Department of Cardiovascular Surgery, University of Freiburg, Hugstetterstrasse 55, 79106 Freiburg, Germany.
Msiegenth{at}aol.com
OBJECTIVES: We sought to evaluate the surgical results and effects of continuous support with the permanent Jarvik-2000 left ventricular assist device (LVAD). We report the early outcomes.
BACKGROUND: A shortage of transplant donors necessitates the testing of alternative treatments. The Jarvik-2000 is an axial flow pump with a percutaneous retro-auricular power connector, designed for permanent use.
METHODS: Patients with severe heart failure (HF), unsuitable for heart transplantation or conventional LVAD support, were offered implantation. The surgical approach included a left lateral thoracotomy. The device was implanted into the left ventricular apex on femoro-femoral bypass. It is set to allow pulsatile flow with an aortic valve opening. Anticoagulation is adjusted the same as for patients with a heart valve.
RESULTS: Between May 2001 and August 2001, we implanted the Jarvik-2000 in two patients with dilated cardiomyopathy and in one with cardiac amyloidosis, all with severe HF (cardiac index 1.8 ± 0.3 l/m2 per min). One patient required preoperative inotropic support. All patients did well, with no repeat operations or infections. Patients received 4.3 ± 3.2 packed red blood cells and were intubated at 14 ± 3 h, and the intensive care unit stay was 7.0 ± 0.5 days. The cardiac index increased from 3.7 ± 1.5 l/min per m2 at 8,000 rpm to 5.9 ± 2.9 l/min per m2 at 12,000 rpm. All patients currently have mild hemolysis not requiring transfusion. The following postoperative events were recorded: a transient ischemic attack with complete recovery, a short re-intubation due to ventricular arrhythmia, loss of consciousness with a battery change while standing, knee-joint effusion after ergometry training, a minor wound problem and a short hospital re-admission due to dehydration. Patients were discharged home after 49 ± 7 days; one has returned to work. All quality-of-life scores have improved.
CONCLUSIONS: The permanent Jarvik-2000 appears safe. It can be used for dilative or restrictive disease. The Jarvik-2000 might prove a valid option for the long-term treatment of patients with severe HF.
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