Anesthetic management for implantation of the Jarvik 2000 left ventricular assist system.
The Jarvik 2000 Heart(TM) is a left ventricular assist device that produces continuous nonpulsatile axial flow by means of a single, rotating, vaned impeller. Anesthetic and perioperative considerations of the Jarvik 2000 Heart(TM) differ from those of conventional assist devices. The Jarvik 2000 is implanted within the left ventricle through a left thoracotomy, which is aided by left lung isolation. A brief period of cardiopulmonary bypass and induced ventricular fibrillation facilitate implantation. Transesophageal echocardiography is essential to assure proper intraventricular positioning of the device and aortic outflow, confirmed by observation of aortic valve opening in the presence of adequate left ventricular volume. Because continuous flow devices function best in the presence of lower systemic and pulmonary vascular resistance, milrinone was preferentially used as an inotropic drug. In the first group of 10 patients to receive the Jarvik 2000, the pump provided a cardiac output of up to 8 L/min, depending on preload, afterload, and pump speed. There were no early perioperative deaths. The average support duration was 81.2 days; the range was 13-214 days. Seven of the 10 patients survived to transplantation. Survivors underwent complete physical rehabilitation during pump support.


CONCLUSIONS
The Jarvik 2000 is a left ventricular assist device that produces continuous nonpulsatile axial flow by means of a rotating, vaned impeller. Because the anesthetic considerations differ from those of conventional left ventricular assist devices, we report the perioperative management of the first 10 patients who participated in a bridge-to-transplantation feasibility study of the Jarvik 2000.
D000368:Aged; D000758:Anesthesia; D001013:Aorta, Thoracic / Q000473:pathology / Q000601:surgery; D002302:Cardiac Output / Q000502:physiology; D017548:Echocardiography, Transesophageal; D005260:Female; D006333:Heart Failure / Q000601:surgery; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D020105:Milrinone / Q000627:therapeutic use; D016343:Monitoring, Intraoperative; D019919:Prosthesis Implantation / Q000401:mortality; D014655:Vascular Resistance / Q000502:physiology; D014665:Vasodilator Agents / Q000627:therapeutic use; D016277:Ventricular Function, Left / Q000502:physiology
D014665:Vasodilator Agents; D020105:Milrinone