Avtor/Urednik		Frazier, OH; Myers, Timothy J; Westaby, Stephen; Gregorič, Igor D
Naslov		Use of the Jarvik 2000 left ventricular assist system as a bridge to heart transplantation or as destination therapy for patients with chronic heart failure
Tip		članek
Vir		Ann Surg
Vol. in št.		Letnik 237, št. 5
Leto izdaje		2003
Obseg		str. 631-7
Jezik		eng
Abstrakt		Objective: To evaluate the Jarvik 2000 axial flow left ventricular assist system (LVAS) as a bridge to transplant and as destination therapy. Summary background data: The Jarvik 2000 LVAS was implanted in 22 patients (16 men, 6 women; mean age 53 years) as a bridge to transplant (in the United States) and in 4 patients (all men; mean age 62.8 years) as destination therapy (in the United Kingdom). All patients in both of these initial feasibility studies were in NYHA class 4. Methods: The pump was implanted through a thoracotomy or median sternotomy incision with the aid of partial cardiopulmonary bypass in bridge-to-transplant patients. A skull-mounted percutaneous power delivery was used for the patients who received the pump as destination therapy. Results: Of the 22 bridge-to-transplant patients, 13 underwent transplant; 7 died during support; and 2 studies are ongoing. The surviving patients have an average follow-up of 15 months; one died at 2.6 months after transplant, and the remaining patients are all in NYHA class 1. Support averaged 67.1 days. Deaths were due to acute myocardial infarction in two patients and multiorgan failure in five patients. Hemodynamic function improved with LVAS support. The average cardiac index increased 70.6% by 48 hours after implant, pulmonary capillary wedge pressure decreased 44%, systemic vascular resistance decreased significantly, and inotropic support became unnecessary. Similar results have been seen in the patients who received the device as destination therapy. In that series, one patient died of subdural hematoma 380 days after implant. The other two patients are in NYHA class 1, 642 and 889 days after implant. The average cardiac index increased 89.5%, and pulmonary capillary wedge decreased 52.2%. Conclusion: The Jarvik 2000 axial-flow LVAS can be used safely in selected patients to provide support until transplant or as destination therapy. (Abstract truncated at 2000 characters)
Deskriptorji		HEART TRANSPLANTATION HEART-ASSIST DEVICES ADULT AGED HEMODYNAMICS WAITING LISTS