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. 2015 Oct;63(10):557-64.
doi: 10.1007/s11748-015-0538-7. Epub 2015 Mar 24.

Early and mid-term outcomes of left ventricular assist device implantation and future prospects

Hiroki Hata  1 , Tomoyuki Fujita  2 , Yusuke Shimahara  2 , Shunsuke Sato  2 , Masanobu Yanase  3 , Osamu Seguchi  3 , Takuma Sato  3 , Takeshi Nakatani  3 , Junjiro Kobayashi  2
Affiliations

Early and mid-term outcomes of left ventricular assist device implantation and future prospects

Hiroki Hata et al. Gen Thorac Cardiovasc Surg. 2015 Oct.

Abstract

Objectives: Although implantable left ventricular assist device use as a bridge to heart transplantation is increasing, its permanent use as destination therapy is not permitted in Japan. This retrospective review assessed early and mid-term outcomes of implantable continuous-flow left ventricular assist device compared with extracorporeal pulsatile-flow left ventricular assist device implantation. Issues regarding left ventricular assist device as destination therapy are discussed.

Methods: From January 2009 to September 2013, 72 patients underwent left ventricular assist device implantation at our institute. Forty patients were supported by extracorporeal pulsatile-flow left ventricular assist devices (ex-VAD group) and 32 patients with implantable continuous-flow left ventricular assist devices (im-VAD group).

Results: The median duration of ventricular assist device support was 563 days. The actuarial survival rates at 1 and 3 years were 92.3 and 79.2 % in the ex-VAD group and 96.4 and 72.3 % in the im-VAD group, respectively. Approximately 50 % of patients in both groups developed cerebrovascular complications within 1 year postoperatively. Six months post-implantation, almost 90 % of the ex-VAD group patients suffered exit-site infection compared with about 50 % in the im-VAD group. Readmission rate was 1.74 per patient-year; major causes were driveline exit-site infection (52 %) and cerebrovascular complication (14 %).

Conclusions: Early and mid-term outcomes were satisfactory after both extracorporeal pulsatile-flow left ventricular assist device and implantable continuous-flow left ventricular assist device implantation, although a considerable level of postoperative complications was observed. More data after left ventricular assist device surgery are needed to enable its consideration as a destination therapy option in Japan.

Keywords: Bridge to transplant; Destination therapy; Heart transplantation; Left ventricular assist device.

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