Implantation of the permanent Jarvik-2000 left ventricular assist device: a single-center experience.
OBJECTIVE
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/m(2) 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 m(2) at 8,000 rpm to 5.9 +/- 2.9 l/min per m(2) 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.
Siegenthaler
Michael P
MP
Department of Cardiovascular Surgery, University of Freiburg, Hugstetterstrasse 55, 79106 Freiburg, Germany. Msiegenth@aol.com
Martin
Jürgen
J
van de Loo
Andreas
A
Doenst
Torsten
T
Bothe
Wolfgang
W
Beyersdorf
Friedhelm
F
D000686:Amyloidosis / Q000601:surgery*; D002303:Cardiac Output, Low / Q000601:surgery; D002311:Cardiomyopathy, Dilated / Q000601:surgery*; D004867:Equipment Design; D006331:Heart Diseases / Q000601:surgery*; D006353:Heart-Assist Devices / Q000009:adverse effects; D006461:Hemolysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D016896:Treatment Outcome