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Ann Thorac Surg 1989;47:158-166
© 1989 The Society of Thoracic Surgeons

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Articles

Interim use of the Jarvik-7 artificial heart: Lessons learned at Presbyterian-University Hospital of Pittsburgh

Department of Surgery, Presbyterian-University Hospital of Pittsburgh, Pittsburgh, Pennsylvania U.S.A.

^_* Address reprint requests to Dr Griffith, University of Pittsburgh, 1084 Scaife Hall, Pittsburgh, PA 15261.

Between October 1985 and March 1988, 16 patients received the Jarvik-7 total artificial heart as an interim device before transplantation. Ten patients were afflicted with cardiomyopathy, and 6 had end-stage ischemic disease. All but 1 were men; the mean age was 47 years (range, 27 to 59 years). Thirteen patients developed cardiogenic shock despite the use of intravenous inotropic agents (mean, 23 days; range, two to 83 days) and the intraaortic balloon pump (mean, 13 days; range, two to 65 days). Three other patients became candidates because of failed transplantation. The 100-mL Jarvik-7 device was used in the first 3 patients; all subsequent recipients were treated with the 70-mL Jarvik-7. Postoperative anticoagulation was designed to keep the partial thromboplastin time between 2 and 2.5 times control. The control values were obtained during administration of heparin and dypyridamole. In all cases the function of the total artificial heart was adequate to support the needs of the recipient, and there were no mechanical difficulties with the device or the drive system. The average time of implantation was 9 days (range, one to 35 days). Two patients died before transplantation, 1 with sepsis from fungus and the other with hemorrhage from a torn pulmonary arterial anastomosis. Fourteen patients received cardiac allografts, and 7 continue to survive without restrictions. Infection within the mediastinum caused the death of 4 patients after transplantation; in 3 of these mediastinitis was not recognized before transplantation but occurred within the first 2 weeks after transplantation. Of the remaining 3 deaths, 1 was due to failure of the donor heart perioperatively, 1 was due to acute rejection in the setting of treated mediastinitis and reduced immunosuppression, and the third occurred during the ninth postoperative month because of medical noncompliance. The Jarvik-7 total artificial heart has been useful in the bridging application and has functioned flawlessly. The current limiting facto; of its continued use is the strikingly high incidence of mediasti nitis, which does not appear to be related to ascending infection from the drivelines. Our current indications for the use of the device are discussed.

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