Westaby Stephen, Jarvik Robert, Freeland Andrew, Pigott David, Robson Desiree, Saito Satoshi, Catarino Pedro, Frazier O H
Oxford Heart Centre, Oxford, United Kingdom.
J Thorac Cardiovasc Surg. 2002 May;123(5):977-83. doi: 10.1067/mtc.2002.121045.
Percutaneous driveline infection continues to detract from both quality and length of life in patients with a left ventricular assist device. We have pursued an alternative route by using a skull-mounted percutaneous pedestal similar to cochlear implant technology. We have now used this method in patients implanted with the Jarvik 2000 heart (Jarvik Heart, Inc, New York, NY) as destination therapy for end-stage (New York Heart Association class IV) heart failure.
Four men with cardiomyopathy aged 61 to 72 years received the Jarvik 2000 heart with postauricular power delivery for permanent mechanical circulatory support. The power cable was brought through the second posterior intercostal space and routed through the neck to a percutaneous titanium implant screwed to the skull. This joins with the cable to the external controller and battery.
In 3 patients the pedestal healed well and remained free from infection up to 1 year. The system was user friendly, and the whole external apparatus is exchangeable. The second patient had a subdural hematoma. This caused us to improve the preparation and modify the implant procedure.
For widespread use, permanent implantable circulatory support requires a reliable, user-friendly device with freedom from powerline infection. Our early experience with the Jarvik 2000 heart suggests that rigid fixation and the vascularity of scalp skin promote healing and reduce the risk of driveline infection.
经皮驱动线感染持续影响左心室辅助装置患者的生活质量和寿命。我们采用了一种类似于人工耳蜗技术的颅骨植入式经皮基座的替代方法。我们现已将此方法应用于植入Jarvik 2000心脏（Jarvik Heart公司，纽约州纽约市）作为终末期（纽约心脏协会IV级）心力衰竭目标治疗的患者。
4名年龄在61至72岁之间的心肌病男性接受了Jarvik 2000心脏，并通过耳后供电进行永久性机械循环支持。电源线穿过第二后肋间间隙，经颈部引至拧在颅骨上的经皮钛植入物。该植入物与连接至外部控制器和电池的电缆相连。
3例患者的基座愈合良好，长达1年无感染。该系统使用方便，整个外部装置可更换。第二例患者发生了硬膜下血肿。这促使我们改进准备工作并修改植入程序。
为了广泛应用，永久性植入式循环支持需要一个可靠、使用方便且无动力线感染的装置。我们对Jarvik 2000心脏的早期经验表明，牢固固定和头皮皮肤的血管供应有助于愈合并降低驱动线感染的风险。
