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Eur J Cardiothorac Surg 2002;22:228-232
© 2002 Elsevier Science NL
a Department of Cardiac Surgery, Oxford Heart Centre, The John Radcliffe Hospital, Headleyway, Headington, Oxford OX3 9DU, UK
b Texas Heart Institute, Houston, TX, USA
c Department of Cardiovascular Surgery, University of Freiburg, Freiburg, Germany
d Jarvik Heart Inc., New York, NY, USA
Received 18 September 2001; received in revised form 8 February 2002; accepted 9 April 2002.
* Corresponding author. Tel.: +44-1865-220269; fax: +44-1865-220268
e-mail: swestaby{at}ahf.org.uk
Objective: Heart failure is now a public health epidemic. Donor hearts are severely restricted in availability. Permanent mechanical circulatory support or bridge to myocardial recovery are emerging alternatives. After extensive laboratory experience we sought to evaluate the intraventricular Jarvik 2000 Heart in patients with endstage heart failure. Methods: The Jarvik 2000 Heart is a novel thumb-sized left ventricular assist device (LVAD) which is fitted within the apex of the native left ventricle. A vascular graft off loads this to the descending thoracic aorta. The pump rotor spins at between 8000 and 12 000 rpm providing 5–6 litres blood flow per minute. We have used the device with skull-mounted power delivery for seven permanent implants and trans-abdominal drive line for ten bridge-to-transplant patients. Results: All patients survived the operation. Three died from non-device related complications. Survivors had early resolution of heart failure with return to NYHA I/II. All had pulsatile circulation. The device was user-friendly and imperceptible to the patient. Both the pump and native left ventricle contributed to the cardiac output during exercise. Seven patients have been transplanted successfully. All explanted devices were free from thrombus formation. Two permanent implant patients left hospital as early as 3 weeks postoperatively. Conclusions: The Jarvik 2000 is an effective user-friendly LVAD which allows early discharge from hospital. The intraventricular position has distinct advantages especially through absence of an inflow cannula. Synergy develops between the LVAD and native left ventricle. Early experience suggests that this may be a realistic LVAD to treat heart failure routinely in the outpatient setting.
Key Words: Heart failure • Left ventricular assist device
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