First Biventricular Jarvik 2000 Implants (Retroauricular Version) Via a Median Sternotomy

Area of Science:

• Cardiology
• Biomedical Engineering
• Mechanical Circulatory Support

Background:

• Rising numbers of elderly patients ineligible for heart transplants necessitate alternative advanced therapies.
• The Jarvik 2000 assist device offers advantages like a retroauricular power supply, reducing driveline infection risks.
• Biventricular implantation of the Jarvik 2000 may provide crucial support for patients with biventricular heart failure as destination therapy.

Observation:

• Three male patients (mean age 65.3 years) with severe biventricular dysfunction (ejection fractions 24.7% LV, 17.7% RV) received biventricular Jarvik 2000 assist devices.
• This marked the first global implantation of biventricular Jarvik 2000 systems with retroauricular power supply via median sternotomy and additional cardiac procedures.
• Mean support duration was 224 days, with no technical device issues observed during implantation or support.

Findings:

• All three patients achieved adequate cardiac support from the biventricular Jarvik 2000 system.
• Two patients succumbed to non-cardiac complications: postoperative hepatic failure and intestinal complications.
• The third patient died from ventricular fibrillation after 1.5 years, despite significant improvement in right ventricular function (48% ejection fraction increase) and right ventricular pump shutdown.

Implications:

• Biventricular assist device implantation, specifically the Jarvik 2000, shows promise as a destination therapy for elderly, non-transplant candidates with advanced heart failure.
• Mortality in this cohort was attributed to comorbidities and surgical complications, not device malfunction.
• Further research and strategies to mitigate complication rates are essential to establish biventricular assist devices as a viable alternative to heart transplantation.