title: Improved long-term performance of pulsatile extracorporeal left ventricular assist device.
abstract: OBJECTIVE
  The majority of heart transplant (HTx) candidates require left ventricular assist device (LVAD) support for more than 2 years before transplantation in Japan. However, the only currently available device is the extracorporeal pulsatile LVAD. The long-term management of extracorporeal LVAD support has improved remarkably over the years. To determine which post-operative management factors are related to the long-term survival of patients on such LVAD, we retrospectively compared the incidence of complications and their management strategies between the initial and recent eras of LVAD use, classified by the year of LVAD surgery.
  
  
  METHODS
  Sixty-nine consecutive patients supported by extracorporeal pulsatile LVAD as a bridge to HTx between 1994 and 2007 were reviewed retrospectively. The patients were assigned according to the time of LVAD surgery to either group A (n=30; between 1994 and 2000) or group B (n=39; between 2001 and 2007).
  
  
  RESULTS
  Patients in group B survived significantly longer on LVAD support than those in group A (674.6 vs. 369.3 days; p<0.001). The 1- and 2-year survival rates were significantly higher in group B than that in group A (82% vs. 48%, p<0.0001; 68% vs. 23%, p<0.0001, respectively). The proportion of deaths due to cerebrovascular accidents was lower (17% vs. 50%, p<0.001) in group B compared with group A. The incidences of systemic infection were similar in both groups, but the proportions of patients alive and achieving transplant surgery after systemic infection were higher in group B than those in group A (55% vs. 14%, p<0.01; 14% vs. 36%, p<0.05, respectively).
  
  
  CONCLUSIONS
  The long-term survival of patients even on "first-generation" extracorporeal LVAD has improved significantly in the recent era. Careful management of cerebrovascular accidents and systemic infection will play important roles in the long-term LVAD management.
authors.affiliation: Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
authors.forename: Taro
authors.initials: T
authors.lastname: Sasaoka
authors.forename: Tomoko S
authors.initials: TS
authors.lastname: Kato
authors.forename: Kazuo
authors.initials: K
authors.lastname: Komamura
authors.forename: Ayako
authors.initials: A
authors.lastname: Takahashi
authors.forename: Ikutaro
authors.initials: I
authors.lastname: Nakajima
authors.forename: Noboru
authors.initials: N
authors.lastname: Oda
authors.forename: Akihisa
authors.initials: A
authors.lastname: Hanatani
authors.forename: Akiko
authors.initials: A
authors.lastname: Mano
authors.forename: Masanori
authors.initials: M
authors.lastname: Asakura
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Hashimura
authors.forename: Kazuo
authors.initials: K
authors.lastname: Niwaya
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Funatsu
authors.forename: Junjiro
authors.initials: J
authors.lastname: Kobayashi
authors.forename: Soichiro
authors.initials: S
authors.lastname: Kitamura
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Shishido
authors.forename: Kyoichi
authors.initials: K
authors.lastname: Wada
authors.forename: Shigeki
authors.initials: S
authors.lastname: Miyata
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nakatani
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Isobe
authors.forename: Masafumi
authors.initials: M
authors.lastname: Kitakaze
mesh_terms: D000328:Adult; D005260:Female; D016027:Heart Transplantation; D006352:Heart Ventricles; D006353:Heart-Assist Devices; D006801:Humans; D007239:Infections / Q000209:etiology; D008297:Male; D009026:Mortality; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome