Hemodynamic characteristics of the Jarvik-7 total artificial heart.

ABSTRACT

To identify the optimal means of artificial circulation, driving controls and resultant hemodynamics were correlated with clinical outcomes in 37 Jarvik-7 recipients up to 72 hours after implantation. When patients with subsequent transplantation (n = 16) were compared with those who died on the Jarvik-7 heart (n = 21), there were no significant differences in total artificial heart driving mode such as frequency, ventricular driving pressures, systolic-diastolic ratio, or vacuum use, nor were there any differences in the hemodynamics achieved, such as device output (cardiac output) or atrial filling pressures, throughout the observation. However, improvements of other organ functions, especially kidney and liver, were remarkable in that transplant patients immediately experienced increased urine output and reversal of secondary organ dysfunction. The nontransplant group failed to diurese and continued to deteriorate despite similar hemodynamics. When a smaller model of the Jarvik-7 (volume of 70 ml, n = 18) was compared with the standard model (volume of 100 ml, n = 19), again there were no significant differences except that ventricular stroke volume was consistently less for the 70-ml model. Because of a slightly higher heart rate in the smaller model, device output did not differ between recipients of the two types. The results suggest that once successfully implanted, the Jarvik-7 provides adequate perfusion without associated mortality from circulatory failure, regardless of the size of the ventricle. Recovery from other organ failure appears to be independent of postimplant hemodynamics, a phenomenon that suggests the importance of preimplant status and patient selection.