Bridge to transplantation with the Jarvik-7 (CardioWest) total artificial heart: a single-center 15-year experience.
BACKGROUND
At our institution, the total artificial heart (TAH) Jarvik-7 (CardioWest) has been used since 1986 as a bridge to transplantation for the most severely ill patients with terminal congestive heart failure.


METHODS
Between 1986 and 2001, 127 patients (108 males, mean age 38 +/- 13) were bridged to transplantation with the Jarvik-7 TAH. All were in terminal biventricular failure despite high-dose inotropic support. Nine patients had a body surface area (BSA) of <1.6 m(2). In Group I patients (78%), the etiology of cardiac failure was dilated cardiomyopathy, either idiopathic (n = 60) or ischemic (n = 38). The other 29 patients (Group II) had disease of miscellaneous origin. We analyzed our experience with regard to 3 time periods: 1986 to 1992 (n = 63); 1993 to 1997 (n = 36); and 1998 to 2001 (n = 33).


RESULTS
Although Group II patients represented 30% of indications before 1992, they comprised only 15% during the 2 subsequent periods. Duration of support for transplant patients increased dramatically after 1997, reaching 2 months for the most recent period (5 to 271 days). In Group I, the percentage of transplanted patients increased from 43% before 1993 to 55% between 1993 and 1997, and reached 74% thereafter. The major cause of death was multiorgan failure (67%). The clinical thromboembolic event rate was particularly low with no instance of cerebrovascular accident and 2 transient ischemic attacks. Total bleeding complication rate was 26%, including 2 deaths related to intractable hemorrhage and 2 others related to atrial tamponade. The cumulative experience was 3,606 total implant days with only 1 instance of mechanical dysfunction.


CONCLUSIONS
TAH is a safe and efficient bridge for patients with terminal congestive heart failure awaiting cardiac transplantation.
Leprince
P
P
Department of Cardiothoracic Surgery, La Pitié-Salpétrière Hospital, Paris, France. pascal.leprince@psl.ap-hop-paris.fr
Bonnet
N
N
Rama
A
A
Léger
P
P
Bors
V
V
Levasseur
J P
JP
Szefner
J
J
Vaissier
E
E
Pavie
A
A
Gandjbakhch
I
I
D000293:Adolescent; D000328:Adult; D001794:Blood Pressure / Q000502:physiology; D002302:Cardiac Output / Q000502:physiology; D002648:Child; D005260:Female; D006333:Heart Failure / Q000503:physiopathology* / Q000628:therapy*; D016027:Heart Transplantation; D006354:Heart, Artificial; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome