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Implantation of Left Ventricular Assist Device (LVAD) in Juvenile Landrace Swine: A LVAD Implantation Model of Pediatric Heart Failure
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Implantation of Left Ventricular Assist Device (LVAD) in Juvenile Landrace Swine: A LVAD Implantation Model of Pediatric Heart Failure

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

Hiroki Hata1, Tomoyuki Fujita2, Yusuke Shimahara2

  • 1Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan. hatahiro@ncvc.go.jp.

General Thoracic and Cardiovascular Surgery
|March 25, 2015
PubMed

Insights

Both implantable continuous-flow and extracorporeal pulsatile-flow ventricular assist devices show satisfactory outcomes. However, complications like infections and cerebrovascular events require further investigation for destination therapy in Japan.

Area of Science:

  • Cardiology
  • Medical Devices
  • Surgical Outcomes

Background:

  • Left ventricular assist device (LVAD) use is increasing for heart failure patients.
  • Destination therapy with LVADs is not currently approved in Japan.
  • Continuous-flow and pulsatile-flow LVADs represent different technological approaches.

Purpose of the Study:

  • To compare early and mid-term outcomes of implantable continuous-flow LVADs versus extracorporeal pulsatile-flow LVADs.
  • To discuss the feasibility of LVADs as destination therapy in the Japanese context.

Main Methods:

  • Retrospective review of 72 patients undergoing LVAD implantation from January 2009 to September 2013.
  • Comparison between 40 patients with extracorporeal pulsatile-flow LVADs (ex-VAD) and 32 with implantable continuous-flow LVADs (im-VAD).

Main Results:

  • Actuarial survival rates at 1 and 3 years were comparable between groups (e.g., 92.3% vs. 96.4% at 1 year).
  • High rates of cerebrovascular complications (approx. 50% within 1 year) and exit-site infections (90% in ex-VAD vs. 50% in im-VAD at 6 months) were observed.
  • Readmission rates were significant, primarily due to driveline exit-site infections and cerebrovascular complications.

Conclusions:

  • Both ex-VAD and im-VAD demonstrated satisfactory early and mid-term outcomes.
  • A considerable burden of postoperative complications necessitates further study.
  • Additional data are required to consider LVADs for destination therapy in Japan.
Abstract

Keywords:
Bridge to transplantDestination therapyHeart transplantationLeft ventricular assist device

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