Technology and technique for left ventricular assist device optimization: A Bi-Tech solution.
Jarvik 2000
cone-bearing
minimally-invasive
Journal
Artificial organs
ISSN: 1525-1594
Titre abrégé: Artif Organs
Pays: United States
ID NLM: 7802778
Informations de publication
Date de publication:
Dec 2022
Dec 2022
Historique:
revised:
18
06
2022
received:
09
04
2022
accepted:
14
07
2022
pubmed:
23
7
2022
medline:
18
11
2022
entrez:
22
7
2022
Statut:
ppublish
Résumé
We investigated the synergistic effect of the new cone-bearing design of Jarvik 2000 (Jarvik Heart Inc., NY) together with a minimally-invasive approach to outcomes of LVAD patients. We retrospectively reviewed all patients from 5 institutions involved in the Jarvik 2000 Italian Registry, from October 2008 to October 2016. Patients were divided into three groups according to pump design and implantation technique: pin-bearing design and conventional approach (Group 1); cone-bearing and conventional approach (Group 2); cone-bearing and minimally-invasive implantation (Group 3). A total of 150 adult patients with end-stage heart failure were enrolled: 26 subjects in Group 1, 74 in Group 2, and 50 in Group 3. Nineteen patients (73%) in Group 1, 51 (69%) in Group 2, and 36 (72%) in Group 3 were discharged. During follow-up, 22 patients underwent transplantation, while in 3 patients the LVAD was explanted. The overall 1-year survival was 58 ± 10%, 64 ± 6%, and 74% ± 7% in Groups 1, 2, and 3, respectively (p = 0.034). The competing-risks-adjusted cumulative incidence rate for adverse events was 42.1 [27-62.7] per 100 patient-years in Group 1, 35.4 [25.3-48.2] in Group 2, and 22.1 [12.4-36.4] in Group 3 (p = 0.046 for Group 1 vs. 3). The association of the modern cone-bearing configuration of Jarvik 2000 and minimally invasive surgery improved survival and minimized the risk for cardiovascular events, as a result of combining technology and technique.
Sections du résumé
BACKGROUND
BACKGROUND
We investigated the synergistic effect of the new cone-bearing design of Jarvik 2000 (Jarvik Heart Inc., NY) together with a minimally-invasive approach to outcomes of LVAD patients.
METHODS
METHODS
We retrospectively reviewed all patients from 5 institutions involved in the Jarvik 2000 Italian Registry, from October 2008 to October 2016. Patients were divided into three groups according to pump design and implantation technique: pin-bearing design and conventional approach (Group 1); cone-bearing and conventional approach (Group 2); cone-bearing and minimally-invasive implantation (Group 3).
RESULTS
RESULTS
A total of 150 adult patients with end-stage heart failure were enrolled: 26 subjects in Group 1, 74 in Group 2, and 50 in Group 3. Nineteen patients (73%) in Group 1, 51 (69%) in Group 2, and 36 (72%) in Group 3 were discharged. During follow-up, 22 patients underwent transplantation, while in 3 patients the LVAD was explanted. The overall 1-year survival was 58 ± 10%, 64 ± 6%, and 74% ± 7% in Groups 1, 2, and 3, respectively (p = 0.034). The competing-risks-adjusted cumulative incidence rate for adverse events was 42.1 [27-62.7] per 100 patient-years in Group 1, 35.4 [25.3-48.2] in Group 2, and 22.1 [12.4-36.4] in Group 3 (p = 0.046 for Group 1 vs. 3).
CONCLUSIONS
CONCLUSIONS
The association of the modern cone-bearing configuration of Jarvik 2000 and minimally invasive surgery improved survival and minimized the risk for cardiovascular events, as a result of combining technology and technique.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2486-2492Informations de copyright
© 2022 International Center for Artificial Organs and Transplantation and Wiley Periodicals LLC.
Références
Jarvik R. Jarvik 2000 pump technology and miniaturization. Heart Fail Clin. 2014 Jan;10(Suppl 1):S27-38.
Selzman CH, Koliopoulou A, Glotzbach JP, McKellar SH. Evolutionary improvements in the Jarvik 2000 left ventricular assist device. ASAIO J. 2018 Nov/Dec;64(6):827-30.
Tarzia V, di Giammarco G, di Mauro M, Bortolussi G, Maccherini M, Tursi V, et al. From bench to bedside: can the improvements in left ventricular assist device design mitigate adverse events and increase survival? J Thorac Cardiovasc Surg. 2016 Jan;151(1):213-7.
Gerosa G, Gallo M, Tarzia V, Di Gregorio G, Zanella F, Bottio T. Less invasive surgical and perfusion technique for implantation of the Jarvik 2000 left ventricular assist device. Ann Thorac Surg. 2013 Aug;96(2):712-4.
Tarzia V, Buratto E, Dal Lin C, Gallo M, Bortolussi G, Bejko J, et al. Jarvik 2000: evolution of surgical implantation from conventional to minimally invasive technique. Ann Cardiothorac Surg. 2014 Nov;3(6):621-3.
Bottio T, Bejko J, Guariento A, Tarzia V, Pittarello D, Gerosa G. Bilateral mini-thoracotomy off-pump Jarvik 2000 implantation in regional asymmetric paravertebral analgesia. J Cardiovasc Med (Hagerstown). 2016 Feb;17(2):160-4.
Bejko J, Pittarello D, Falasco G, di Gregorio G, Tarzia V, Rizzoli G, et al. A pilot study on the efficacy and safety of a minimally invasive surgical and anesthetic approach for ventricular assist device implantation. Int J Artif Organs. 2017 Oct;16:28-36.
Tarzia V, di Giammarco G, Bagozzi L, Bortolussi G, Maccherini M, Marinelli D, et al. From bench to bedside: impact of left ventricular assist device outflow conduit anastomosis position on outcome. Artif Organs. 2021 Mar;45(3):236-43.
Selzman CH, Feller ED, Walker JC, Sheridan BC, Silvestry SC, Daly RC, et al. The Jarvik 2000 left ventricular assist device: results of the United States bridge to transplant trial. ASAIO J. 2022 Apr 13. https://doi.org/10.1097/MAT.0000000000001750. [Epub ahead of print]