Article

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

Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield Hospital, London, UK.
The Journal of thoracic and cardiovascular surgery (Impact Factor: 3.41). 08/2007; 134(1):199-203. DOI: 10.1016/j.jtcvs.2007.01.002
Source: PubMed

ABSTRACT 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.
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.
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.
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.

0 Bookmarks
 · 
180 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: An implantable, compact rotary blood pump has been newly developed using an axial flow turbo pump with hydrodynamic bearings. The rotating impeller, which is hydrodynamically levitated with the assistance of repulsive magnetic force, has no contact with the inner surface of the pump. To evaluate the hemodynamic performance and biocompatibility, the pump was installed into four calves for up to 90 days. The pump was installed in the left heart bypass fashion, and placed paracorporeally in the first two calves and in the thoracic cavity in the other two calves. All calves received anticoagulation and antiaggregation therapy during the study. Aortic pressure, heart rate and pump-operating parameters were continuously measured. Hematologic and biochemical tests to evaluate anemia, hepato-renal function and the extent of hemolysis were performed on schedule. Each calf was killed at the termination of the experiments, and pathological analysis for the biocompatibility of the pump system was performed, including the thrombi in the device, emboli in the systemic organs and signs of infection. The pump stably produced a flow of 5 l/min. Each calf was supported for 78, 50, 90 and 90 days, respectively, with no incidence of hemorrhage, organ failure or significant hemolysis. No thrombus formation or mechanical wearing was observed inside the pump. There was no evidence of heat injury around the pump. Device-related infections were observed, but the severity of infection was mild in the implant case compared to the paracorporeal case. The pump demonstrated acceptable hemodynamic performance and biocompatibility in the initial in vivo testing.
    Journal of Artificial Organs 03/2011; 14(1):31-8. · 1.41 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Currently available ventricular assist devices are designed primarily for use in patients with left sided heart failure. This study evaluated the efficacy of the Jarvik 2000 ventricular assist device (VAD) as a pulmonary pump to power a Fontan circuit in a large animal model.
    International journal of cardiology. 08/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this study was to evaluate our clinical experience with the Jarvik 2000 axial flow pump (Jarvik Heart, Inc, New York, NY, USA), a miniature axial flow left ventricular assist device (LVAD). The clinical results of eight patients, who underwent LVAD implantation with the Jarvik 2000 (median age 55.0 years; six men) between 2005 and 2010, including two who participated in a multicenter clinical trial in Japan, were reviewed. Two patients underwent LVAD implantation as destination therapy. Four patients underwent Jarvik 2000 implantation via median sternotomy, while the other four underwent implantation via left thoracotomy. There were no major complications during surgery. Four patients were supported for more than 2 years. The longest support duration was 1,618 days. Six patients successfully bridged to heart transplantation after a median 725 days of support. One patient on destination therapy died of a cerebral infarction. The other patient on destination therapy had had the LVAD for 1,618 days. The overall survival rates at 1, 2, and 3 years were 100, 86, and 86 %, respectively. The median postoperative serum lactate dehydrogenase level was 860.5 U/L at 1 month, 735 U/L at 6 months, and 692 U/L at 1 year. There were no fatal device-related infections. We found that the Jarvik 2000 with pin bearing could support patients with end-stage heart failure with acceptable mortality and morbidity rates. Further evaluations of the prevalence of thromboembolic and hemolytic events in patients with the new conical-bearing Jarvik 2000 are required.
    Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs. 07/2014;