title: The Jarvik 2000 is associated with less infections than the HeartMate left ventricular assist device.
abstract: OBJECTIVE
  Device-related infections remain a considerable problem of left-ventricular support. We compared the device-related-infections between the HeartMate left ventricular assist device (LVAD) and the Jarvik 2000 permanent LVAD, a device with a novel retroauricular power-supply.
  
  
  METHODS
  Between December 2000 and September 2002 we implanted the HeartMate-vented, electrical-system in 11 patients and the permanent Jarvik 2000 in six patients. Total support time was 1626 patient-days (HeartMate, 26-271 days) versus 1246 patient-days (Jarvik 2000, 8-411 days). As potential risk factors for infection we analyzed age, preoperative hospital-days, total protein, cardiac index, maximal oxygen uptake, use of inotropes, LVAD risk-score-index and Aaronson-Mancini-score, intubation time, and intensive care unit stay. We used the Center of Disease Control definitions for surgical site infections.
  
  
  RESULTS
  HeartMate-patients were younger than Jarvik 2000 patients (46+/-13 versus 58+/-6 years, P=0.056), there were no other differences in the risk factors. Four HeartMate-patients needed late (>or=48 h) surgical revisions for bleeding/hematomas versus no revisions in the Jarvik 2000 patients. In the HeartMate-patients, there were seven (64%) driveline-infections, five (45%) device-pocket infections, and three (27%) bloodstream-infections, or 0.43 device-related infections/100 patient-days. Infections occurred early (34+/-31 days). Three patients required urgent transplantation due to bloodstream infection. There were no adverse outcomes in the HeartMate-group due to infection. In the Jarvik 2000 patients, there was one driveline-infection (16%) after 270 days of support (0.08 device-related infections/100 patient-days), significantly less than in the HeartMate-group (P=0.044). Driveline infections resolved with antibiotics and local wound care in the Jarvik 2000 patient, but only in one of seven HeartMate-patients.
  
  
  CONCLUSIONS
  Implantation of the Jarvik 2000 is associated with less device-related infections than the HeartMate-LVAD. The power-supply of the permanent Jarvik 2000 is suitable for long-term mechanical support.
authors.affiliation: Department of Cardiovascular Surgery, Albert-Ludwigs University Freiburg, Germany. siegenth@ch11.ukl.uni-freiburg.de
authors.forename: M P
authors.initials: MP
authors.lastname: Siegenthaler
authors.forename: J
authors.initials: J
authors.lastname: Martin
authors.forename: K
authors.initials: K
authors.lastname: Pernice
authors.forename: T
authors.initials: T
authors.lastname: Doenst
authors.forename: S
authors.initials: S
authors.lastname: Sorg
authors.forename: G
authors.initials: G
authors.lastname: Trummer
authors.forename: O
authors.initials: O
authors.lastname: Friesewinkel
authors.forename: F
authors.initials: F
authors.lastname: Beyersdorf
mesh_terms: D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use; D016527:Drug Costs; D005260:Female; D006333:Heart Failure / Q000191:economics / Q000628:therapy*; D006353:Heart-Assist Devices / Q000009:adverse effects* / Q000191:economics; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D011474:Prosthesis Design; D016459:Prosthesis-Related Infections / Q000188:drug therapy / Q000191:economics / Q000382:microbiology*; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis
chemical_list: D000900:Anti-Bacterial Agents