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J Thorac Cardiovasc Surg 2007;134:199-203
© 2007 The American Association for Thoracic Surgery

Cardiothoracic Transplantation

Midterm experience with the Jarvik 2000 axial flow left ventricular assist device

^a Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield Hospital, London, UK
^b National Heart and Lung Institute, Imperial College, London, UK.

Received for publication September 8, 2006; revisions received November 14, 2006; accepted for publication January 5, 2007.

^_* Address for reprints: Dr Emma Birks, MRCP, PhD, Consultant in Transplant Cardiology and Mechanical Circulatory Support, Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield Hospital, Hill End Road, Harefield, Middlesex, London, UK. (Email: e.birks{at}imperial.ac.uk).

Objective: Rotary axial flow pumps have several potential advantages and disadvantages over pulsatile pumps. The Jarvik 2000 is distinctive in being intracardiac. We report our experience in 22 patients.

Methods: The Jarvik 2000 was implanted in 15 men and 7 women. Mean age was 38.8 (range 23–59) years, preoperative diagnosis was dilated cardiomyopathy in 16, postpartum cardiomyopathy in 3, ischemic heart disease in 2, and chronic allograft failure in 1. Twenty-one patients were in New York Heart Association class IV, and 1 patient was in class III. Nineteen patients were on inotropic support, 6 were supported with an intra-aortic balloon pump, and 2 patients had been salvaged with a Centrimag (Levitronix) ventricular assist device. The median pulmonary vascular resistance was 3 Wood units; median pulmonary capillary wedge pressure was 26.6 mm Hg; and mean Cardiac Index was 1.5 L/min/m².

Results: There were 2 early deaths and 6 late deaths. The average postoperative ventilation time and Intensive Treatment Unit stay was 2.2 and 10 days, respectively. One patient required a right ventricular assist device for short-term support and another for medium-term support. Seven patients were bridged to transplant, 3 had myocardial recovery, and 4 are ongoing. Mean and total duration of support was 280.5 and 6172 days, respectively. Driveline failures were noted in 3, but there were no pump infections or failure.

Conclusion: The Jarvik 2000 provides satisfactory intermediate-term results as a bridge to transplant or recovery. It appears to be associated with a low rate of serious driveline or pump infections and technical failure. However, bleeding complications due to the required anticoagulation treatment frequently occurred.