title: From bench to bedside: Can the improvements in left ventricular assist device design mitigate adverse events and increase survival?
abstract: OBJECTIVE
  In vitro tests demonstrated that the new cone-bearing configuration of the Jarvik 2000 (Jarvik Heart Inc, New York, NY) left ventricular assist device exhibits better hydraulic efficiency than the previous pin-bearing design. We investigated the long-term outcomes of patients who received the Jarvik 2000 left ventricular assist device, depending on bearing design.
  
  
  METHODS
  A retrospective review of prospectively collected data from 18 centers included in the Italian Registry was performed. From May 2008 to September 2013, 99 patients with end-stage heart failure were enrolled. Patients were divided into 2 groups according to their Jarvik 2000 suspending mechanism: Group pin included patients with pin bearings (May 2008 to June 2010), and group cone included patients with newer cone bearings (July 2010 to September 2013). The 2 groups did not differ significantly in terms of baseline characteristics.
  
  
  RESULTS
  A total of 30 of 39 patients (group pin) and 46 of 60 patients (group cone) were discharged. During follow-up, 6 patients underwent transplantation, and in 1 patient the left ventricular assist device was explanted. The cumulative incidence competing risk of the entire cohort for noncardiovascular-related death was 28% (20%-40%); the cumulative incidence competing risk for cardiovascular-related death was 56% (42%-73%): 71% in group pin versus 26% in group cone (P = .034). The multivariate analyses confirmed that the pin-bearing design was a risk factor for cardiovascular death, along with Interagency Registry for Mechanically Assisted Circulatory Support class. Right ventricular failures and ischemic and hemorrhagic strokes were significantly higher in group pin.
  
  
  CONCLUSIONS
  Patients with the new pump configuration showed a better freedom from cardiovascular death and lower incidence of fatal stroke and right ventricular failure. Further studies are needed to prove the favorable impact of pump-enhanced fluid dynamics on long-term results.
authors.affiliation: Cardiac Surgery, University of Padova, Padova, Italy. Electronic address: v.tarzia@gmail.com.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Tarzia
authors.affiliation: Cardiac Surgery, University of Chieti, Chieti, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Di Giammarco
authors.affiliation: Cardiac Surgery, University of Chieti, Chieti, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Di Mauro
authors.affiliation: Cardiac Surgery, University of Padova, Padova, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Bortolussi
authors.affiliation: Cardiac Surgery, University of Siena, Siena, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Maccherini
authors.affiliation: Cardiac Surgery, University of Udine, Udine, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Tursi
authors.affiliation: Cardiac Surgery, University of Udine, Udine, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Maiani
authors.affiliation: Cardiac Surgery, University of Siena, Siena, Italy.
authors.forename: Sonia
authors.initials: S
authors.lastname: Bernazzali
authors.affiliation: Cardiac Surgery, University of Chieti, Chieti, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Marinelli
authors.affiliation: Cardiac Surgery, University of Chieti, Chieti, Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Foschi
authors.affiliation: Cardiac Surgery, University of Padova, Padova, Italy.
authors.forename: Edward
authors.initials: E
authors.lastname: Buratto
authors.affiliation: Cardiac Surgery, University of Padova, Padova, Italy.
authors.forename: Jonida
authors.initials: J
authors.lastname: Bejko
authors.affiliation: Cardiac Surgery, University of Padova, Padova, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Gregori
authors.affiliation: Cardiac Surgery, University of Padova, Padova, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Scuri
authors.affiliation: Cardiac Surgery, University of Udine, Udine, Italy.
authors.forename: Ugolino
authors.initials: U
authors.lastname: Livi
authors.affiliation: Cardiac Surgery, University of Siena, Siena, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Sani
authors.affiliation: Cardiac Surgery, University of Padova, Padova, Italy.
authors.forename: Tomaso
authors.initials: T
authors.lastname: Bottio
authors.affiliation: Cardiac Surgery, University of Padova, Padova, Italy.
authors.forename: Gino
authors.initials: G
authors.lastname: Gerosa
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000453:epidemiology; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006353:Heart-Assist Devices / Q000009:adverse effects; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D020300:Intracranial Hemorrhages / Q000453:epidemiology; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000453:epidemiology; D016277:Ventricular Function, Left
keywords: Jarvik 2000; LVAD; bearing system; follow-up; heart failure; ventricular assist device