Destination therapy with a rotary blood pump and novel power delivery.
OBJECTIVE
We tested the hypothesis that a miniaturised axial flow pump with infection-resistant power delivery could improve longevity and quality of life (QOL) in advanced heart failure patients deemed unsuitable for transplantation.


METHODS
The study included all non-United States Jarvik 2000 patients (n=46), where a skull-pedestal-based power line was employed with the intention of long-term support. Patient age ranged from 29 to 80 years. Of the 46 patients, 42 were male. All were New York Heart Association (NYHA) IV predominantly with idiopathic dilated (n=22) or ischaemic (n=18) cardiomyopathy. The experience (2000-2008) included the learning curve of 10 centres.


RESULTS
The internal components are imperceptible. The power/control system is user friendly, allowing excellent QOL. There has been no pump malfunction. The Kaplan-Meier survival analysis is shown. The longest event-free survival is 7.5 years. Support exceeded 3 years in five cases. The cumulative experience exceeds 50 years. Three patients were transplanted, and two pumps were replaced at 90 and 203 days. Nineteen cases are ongoing (mean: 663 days), while 22 died during support (mean survival: 402 days), of which five from non-device-related diseases. Temporary local infection occurred in three pedestals, and there has been no pump infection. Incidence of thrombo-embolic events showed wide variation between centres.


CONCLUSIONS
From this learning-curve experience, both left ventricular assist device (LVAD) and power delivery are reliable and promising for destination therapy. Early mortality is similar to other studies and relates to the severity of illness. Pump infection has not occurred and prolonged event-free survival is clearly possible with expert medical management.
Westaby
Stephen
S
Department of Cardiothoracic Surgery, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK. swestaby@ahf.org.uk
Siegenthaler
Michael
M
Beyersdorf
Friedhelm
F
Massetti
Massimo
M
Pepper
John
J
Khayat
Andre
A
Hetzer
Roland
R
Frazier
Oscar Howard
OH
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001243:Assisted Circulation / Q000295:instrumentation / Q000379:methods*; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D008134:Long-Term Care / Q000379:methods; D008297:Male; D008875:Middle Aged; D008904:Miniaturization; D011474:Prosthesis Design; D013908:Thoracotomy / Q000379:methods