Implantation of the permanent Jarvik-2000 left ventricular assist device - A single-center experience

OBJECTIVES We sought to evaluate the surgical results and effects of continuous support with the permanent Jarvik-2000 left ventricular assist device (LVAD). We report the early outcomes. BACKGROUND A shortage of transplant donors necessitates the testing of alternative treatments. The Jarvik-2000 is an axial flow pump with a percutaneous retro-auricular power connector, designed for permanent use. METHODS Patients with severe heart failure (HF), unsuitable for heart transplantation or conventional LVAD support, were offered implantation. The surgical approach included a left lateral thoracotomy. The device was implanted into the left ventricular apex on femoro-femoral bypass. It is set to allow pulsatile flow with an aortic valve opening. Anticoagulation is adjusted the same as for patients with a heart valve. RESULTS Between May 2001 and August 2001, we implanted the Jarvik-2000 in two patients with dilated cardiomyopathy and in one with cardiac amyloidosis, all with severe HF (cardiac index 1.8 +/- 0.31/m(2) per min). One patient required preoperative inotropic support. All patients did well, with no repeat operations or infections. Patients received 4.3 +/- 3.2 packed red blood cells and were intubated at 14 +/- 3 h, and the intensive care unit stay was 7.0 +/- 0.5 days. The cardiac index increased from 3.7 +/- 1.5 l/min per in 2 at 8,000 rpm to 5.9 +/- 2.9 l/min per in 2 at 12,000 rpm. All patients currently have mild hemolysis not requiring transfusion. The following postoperative events were recorded: a transient ischemic attack with complete recovery, a short re-intubation due to ventricular arrhythmia, loss of consciousness with a battery change while standing, knee-joint effusion after ergometry training, a minor wound problem and a short hospital re-admission due to dehydration. Patients were discharged home after 49 +/- 7 days; one has returned to work. All quality-of-life scores have improved. CONCLUSIONS The permanent Jarvik-2000 appears safe. It can be used for dilative or restrictive disease. The Jarvik-2000 might prove a valid option for the long-term treatment of patients with severe HF. (C) 2002 by the American College of Cardiology Foundation.