First Clinical Experience of Jarvik 2015 in North America: The New Era of Pediatric-Specific VAD Support

Abstract

Purpose There has been a dramatic increase in adult continuous-flow ventricular assist device (cf-VAD) support in children. Adult VADs in children inevitably cause size mismatch. The unmet need for a pediatric cf-VAD led to initiation of an NIH-funded Pediatric Circulatory Support/PumpKIN program in 2004. The Jarvik 2015 is the only survivor of the program, reflecting the challenges of this initiative. We describe the first clinical experience with the Jarvik 2015 in North America. Methods Results A 4-year-old female (12 kg, BSA 0.5 m2) with a small, non-apex forming left ventricle (LV) with non-compaction and multiple ventricular septal defects (VSDs) required escalation of inotropic support for severe biventricular dysfunction and worsening end-organ function. She previously underwent various procedures including aortic arch repair with pulmonary artery (PA) banding, epicardial pacemaker, and multiple VSD occlusion devices. There were multiple residual defects in the ventricular septum, which was oriented in an axial plane with superior/inferior orientation of the ventricles. Via a 6th sternotomy and LV ventriculotomy, the residual VSDs were closed with a bovine pericardial patch. The LV incision was primarily closed except the most apical portion, leaving an opening for cf-VAD insertion. The outflow graft was anastomosed to the ascending aorta and the PA band was removed (Fig 1). The Jarvik 2015 was set at 15,000 RPMs, and post-op filling pressures were Conclusion This case represents the first Jarvik 2015 implant in North America and first ever implant for a complex congenital heart malformation, heralding the long-awaited PumpKIN trial.