Improved long-term performance of pulsatile extracorporeal left ventricular assist device.
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.
Sasaoka
Taro
T
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
Kato
Tomoko S
TS
Komamura
Kazuo
K
Takahashi
Ayako
A
Nakajima
Ikutaro
I
Oda
Noboru
N
Hanatani
Akihisa
A
Mano
Akiko
A
Asakura
Masanori
M
Hashimura
Kazuhiko
K
Niwaya
Kazuo
K
Funatsu
Toshihiro
T
Kobayashi
Junjiro
J
Kitamura
Soichiro
S
Shishido
Toshiaki
T
Wada
Kyoichi
K
Miyata
Shigeki
S
Nakatani
Takeshi
T
Isobe
Mitsuaki
M
Kitakaze
Masafumi
M
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