Midterm experience with the Jarvik 2000 axial flow left ventricular assist device
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.
Available from: Alanson P Sample
- "laboratory testing and prototype development, the clinical application of TETS has been possible in only two systems (Arrow LionHeart and AbioCor TAH) , . The clinical and laboratory experiments have demonstrated several drawbacks with the current TETS technology. "
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ABSTRACT: Wireless data communication technology has eliminated wired connections for data transfer to portable devices. Wireless power technology offers the possibility of eliminating the remaining wired connection: the power cord. For ventricular assist devices (VADs), wireless power technology will eliminate the complications and infections caused by the percutaneous wired power connection. Integrating wireless power technology into VADs will enable VAD implants to become a more viable option for heart failure patients (of which there are 80 000 in the United States each year) than heart transplants. Previous transcutaneous energy transfer systems (TETS) have attempted to wirelessly power VADs ; however, TETS-based technologies are limited in range to a few millimeters, do not tolerate angular misalignment, and suffer from poor efficiency. The free-range resonant electrical delivery (FREE-D) wireless power system aims to use magnetically coupled resonators to efficiently transfer power across a distance to a VAD implanted in the human body, and to provide robustness to geometric changes. Multiple resonator configurations are implemented to improve the range and efficiency of wireless power transmission to both a commercially available axial pump and a VentrAssist centrifugal pump . An adaptive frequency tuning method allows for maximum power transfer efficiency for nearly any angular orientation over a range of separation distances. Additionally, laboratory results show the continuous operation of both pumps using the FREE-D system with a wireless power transfer efficiency upwards of 90%.
Available from: Jens Garbade
- "The most common implantable pumps are the HeartMate II (Thoratec Corp, Pleasanton, CA, USA), and the Jarvik 2000 (Jarvik Heart Inc.) [16, 17, 22, 29]. Up to date, the HeartMate II is the most successful second-generation pump worldwide and approved as bridge to transplant and as destination therapy [4–7]. "
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ABSTRACT: The shortage of appropriate donor organs and the expanding pool of patients waiting for heart transplantation have led to growing interest in alternative strategies, particularly in mechanical circulatory support. Improved results and the increased applicability and durability with left ventricular assist devices (LVADs) have enhanced this treatment option available for end-stage heart failure patients. Moreover, outcome with newer pumps have evolved to destination therapy for such patients. Currently, results using nonpulsatile continuous flow pumps document the evolution in outcomes following destination therapy achieved subsequent to the landmark Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure Trial (REMATCH), as well as the outcome of pulsatile designed second-generation LVADs. This review describes the currently available types of LVADs, their clinical use and outcomes, and focuses on the patient selection process.
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ABSTRACT: With improved technology and expanding indications for use, left ventricular assist devices (LVADs) are assuming a greater role in the care of patients with end-stage heart failure. Following LVAD implantation with the intention of bridge to transplant, it became evident that some patients exhibit substantial recovery of ventricular function. This prompted explantation of some devices in lieu of transplantation, the so-called bridge-to-recovery (BTR) therapy. However, clinical outcomes following these experiences are not always successful. Patients treated in this fashion have often progressed rapidly back to heart failure. Special knowledge has emerged from studies of hearts supported by LVADs that provides insights into the basic mechanisms of ventricular remodeling and possible limits of ventricular recovery. In general, it was these studies that spawned the concept of reverse remodeling now recognized as an important goal of many heart failure treatments. Important examples of myocardial and/or ventricular properties that do not regress towards normal during LVAD support include abnormal extracellular matrix metabolism, increased tissue angiotensin levels, myocardial stiffening and partial recovery of gene expression involved with metabolism. Nevertheless, studies of LVAD-heart interactions have led to the understanding that although we once considered the end-stage failing heart of patients near death to be irreversibly diseased, an unprecedented degree of myocardial recovery is possible, when given sufficient mechanical unloading and restoration of more normal neurohormonal milieu. Evidence supporting and unsupporting the notion of reverse remodeling and clinical implications of this process will be reviewed.
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