[Current Status of Implantable Ventricular Assist Device]

Area of Science:

• Cardiology
• Medical Devices
• Surgical Technology

Background:

• Implantable ventricular assist devices (iVADs) were first approved in Japan for bridge-to-transplantation (BTT) in 2011.
• The number of iVAD implants has risen significantly, particularly after destination therapy (DT) approval in 2021.
• The increasing use of iVADs, including for DT, impacts heart transplant waiting lists due to donor shortages.

Purpose of the Study:

• To review recent updates on iVAD treatment in Japan.
• To focus on managing device-associated complications in both BTT and DT patients.
• To highlight key complications such as driveline infection, right ventricular failure, and aortic regurgitation.

Main Methods:

• This is a review article summarizing existing data and literature.
• The focus is on clinical outcomes and complications associated with iVADs in Japan.
• Analysis of trends in iVAD implantation for BTT and DT indications.

Main Results:

• Over 1,458 iVAD implants for BTT have been performed since 2011.
• The rate of iVAD implantation is rapidly increasing, especially post-DT approval.
• Device-associated complications, including driveline infection, RV failure, and AR, require careful management for long-term support.

Conclusions:

• Effective management of device-associated complications is essential for improving outcomes in iVAD patients.
• Prolonged iVAD support necessitates strategies to mitigate risks like infection and cardiac dysfunction.
• Addressing complications is critical given the growing use of iVADs and donor limitations in Japan.