Hiroki Kohno1, Goro Matsumiya2, Yoshiki Sawa3, Minoru Ono4, Yoshikatsu Saiki5, Akira Shiose6, Kenji Yamazaki7, Yoshiro Matsui8, Hiroshi Niinami9, Hikaru Matsuda10, Soichiro Kitamura11, Takeshi Nakatani12, Shunei Kyo13. 1. Department of Cardiovascular Surgery, Chiba University Graduate School of Medicine, Chiba, Japan. 2. Department of Cardiovascular Surgery, Chiba University Graduate School of Medicine, Chiba, Japan. Electronic address: matsumg@faculty.chiba-u.jp. 3. Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan. 4. Department of Cardiac Surgery, University of Tokyo, Tokyo, Japan. 5. Department of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan. 6. Department of Cardiovascular Surgery, Kyushu University Faculty of Medical Sciences, Fukuoka, Japan. 7. Department of Cardiovascular Surgery, Tokyo Women's Medical University Hospital, Tokyo, Japan. 8. Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan. 9. Department of Cardiovascular Surgery, Saitama Medical University International Medical Center, Hidaka, Japan. 10. Department of Cardiovascular Surgery, Higashi-Takarazuka Satoh Hospital, Takarazuka, Japan. 11. National Cerebral and Cardiovascular Center, Osaka, Japan. 12. Maki Health Care Group, Maki Hospital, Osaka, Japan. 13. Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan.
Abstract
BACKGROUND: The Jarvik 2000 ventricular assist device features a miniaturized intraventricular pump and an intermittent low-speed function that facilitates aortic valve opening. Despite its long history, little is known about the Jarvik device with regard to post-implantation outcomes. METHODS: Prospectively collected data from 13 participating hospitals were extracted from the Japanese Registry for Mechanically Assisted Circulatory Support database to analyze mortality, morbidity and de-novo aortic regurgitation. Data on 83 patients who underwent implantation of the Jarvik 2000 were reviewed. Median support duration was 191 (maximum 758) days. All recipients underwent implantation as a bridge to transplantation. RESULTS: Overall survival proportions at 1 and 2 years were 85.0% and 79.3%, respectively. Nine patients were in INTERMACS Level 1, and 28 patients were on mechanical circulatory support at the time of implantation. Causes of death included stroke, infection and device malfunction. Three patients had their device removed: 2 at the time of heart transplantation and 1 after recovery of the left ventricle. Common adverse events included major bleeding (27.7%), new infection (31.3%), stroke (20.5%) and device malfunction (20.5%). De-novo aortic regurgitation was observed in 17 patients, 6 of whom developed at least moderate regurgitation during follow-up. CONCLUSIONS: Mid-term survival after Jarvik 2000 implantation was satisfactory and comparable to that reported by other national and international registries (INTERMACS and IMACS) for continuous-flow LVADs. De novo aortic regurgitation occurred despite the intermittent low-speed effect of this device, with some recipients experiencing progressive worsening of aortic regurgitation within 2 years post-implantation.
BACKGROUND: The Jarvik 2000 ventricular assist device features a miniaturized intraventricular pump and an intermittent low-speed function that facilitates aortic valve opening. Despite its long history, little is known about the Jarvik device with regard to post-implantation outcomes. METHODS: Prospectively collected data from 13 participating hospitals were extracted from the Japanese Registry for Mechanically Assisted Circulatory Support database to analyze mortality, morbidity and de-novo aortic regurgitation. Data on 83 patients who underwent implantation of the Jarvik 2000 were reviewed. Median support duration was 191 (maximum 758) days. All recipients underwent implantation as a bridge to transplantation. RESULTS: Overall survival proportions at 1 and 2 years were 85.0% and 79.3%, respectively. Nine patients were in INTERMACS Level 1, and 28 patients were on mechanical circulatory support at the time of implantation. Causes of death included stroke, infection and device malfunction. Three patients had their device removed: 2 at the time of heart transplantation and 1 after recovery of the left ventricle. Common adverse events included major bleeding (27.7%), new infection (31.3%), stroke (20.5%) and device malfunction (20.5%). De-novo aortic regurgitation was observed in 17 patients, 6 of whom developed at least moderate regurgitation during follow-up. CONCLUSIONS: Mid-term survival after Jarvik 2000 implantation was satisfactory and comparable to that reported by other national and international registries (INTERMACS and IMACS) for continuous-flow LVADs. De novo aortic regurgitation occurred despite the intermittent low-speed effect of this device, with some recipients experiencing progressive worsening of aortic regurgitation within 2 years post-implantation.