Postauricular percutaneous power delivery for permanent mechanical circulatory support.
OBJECTIVE
Percutaneous driveline infection continues to detract from both quality and length of life in patients with a left ventricular assist device. We have pursued an alternative route by using a skull-mounted percutaneous pedestal similar to cochlear implant technology. We have now used this method in patients implanted with the Jarvik 2000 heart (Jarvik Heart, Inc, New York, NY) as destination therapy for end-stage (New York Heart Association class IV) heart failure.


METHODS
Four men with cardiomyopathy aged 61 to 72 years received the Jarvik 2000 heart with postauricular power delivery for permanent mechanical circulatory support. The power cable was brought through the second posterior intercostal space and routed through the neck to a percutaneous titanium implant screwed to the skull. This joins with the cable to the external controller and battery.


RESULTS
In 3 patients the pedestal healed well and remained free from infection up to 1 year. The system was user friendly, and the whole external apparatus is exchangeable. The second patient had a subdural hematoma. This caused us to improve the preparation and modify the implant procedure.


CONCLUSIONS
For widespread use, permanent implantable circulatory support requires a reliable, user-friendly device with freedom from powerline infection. Our early experience with the Jarvik 2000 heart suggests that rigid fixation and the vascularity of scalp skin promote healing and reduce the risk of driveline infection.
Westaby
Stephen
S
Oxford Heart Centre, Oxford, United Kingdom. swestaby@AHF.org.uk
Jarvik
Robert
R
Freeland
Andrew
A
Pigott
David
D
Robson
Desiree
D
Saito
Satoshi
S
Catarino
Pedro
P
Frazier
O H
OH
D000368:Aged; D002311:Cardiomyopathy, Dilated / Q000175:diagnosis / Q000601:surgery*; D004867:Equipment Design; D004869:Equipment Safety; D005500:Follow-Up Studies; D006334:Heart Function Tests; D006353:Heart-Assist Devices; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology; D012720:Severity of Illness Index; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology