Rf20 Evolution of Smallest Intracorporeal Continuous Flow Lvad: Roma Experience

Abstract

Objective: Limitations of current VAD for smaller children with HF include use of para-corporeal device, high stroke risk and lack of portability precluding hospital discharge. We report our experience with smallest Jarvik LVAD prototype highlighting the evolution of this device. Methods: A 14-months-old child, weighting 5.6 Kg with DCM and mid-aortic syndrome and a 3 years-old baby, weighting 11 Kg with DCM underwent off-label Jarvik LVAD prototype implantation. Results: Patient 1. After 123 days of Berlin Heart EXCOR LVAD (10 ml) support, the patient developed mediastinitis. He underwent device removal and Levitronix LVAD implantation. After 25 days, we implanted Infant Jarvik 2000. On 13th post-operative day, for a suddenly pump electric blackout, he underwent urgently VA ECMO support and 12 days later, for infection recovery, a new 10ccml BH EXCOR LVAD was implanted. After 17 days of support, he was successfully transplanted and survived to hospital discharge. Patient 2. This child was supported for 166 days with a BH EXCOR LVAD, which was explanted for LV recovery. After 6 days, he developed recurrency of severe HF, needing new LVAD. Because of abdominal cannula site infection, he underwent Infant Jarvik 2015 prototype implantation. Actually, after 3 months of support, is still awaiting heart transplantation. Conclusion: Our pioneering experience showed the feasibility of new smallest Jarvik LVAD and could be considered in future as alternative therapeutic option for LVAD support even in low-weight patients. Further study and larger cohort of patients are necessary to confirm the safety of this new device.