title: [Bridge to bridge surgery;conversion from extracorporeal left ventricular assist device to implantable left ventricular assist device].
abstract: Implantable left ventricular assist devices(I-LVADs)are approved only for bridge to transplantation (BTT) in the Japanese health insurance system, and paracorporeal Nipro-LVAD is the only one therapeutic choice for bridge to decision( BTD) and bridge to candidacy(BTC).Destination therapy(DT)with an I-LVAD is also not approved in Japan yet. Because average waiting period for heart transplantation is over 2 years, bridge to bridge( BTB) surgery, conversion from Nipro-LVAD to an I-LVAD, is often considered after the patient with Nipro-LVAD is approved by the committee as a heart transplantation recipient. Infection at the exit sites of Nipro-LVAD is a strong risk factor for pump pocket infection after BTB, and therefore BTB is not recommended for patients with Nipro-LVAD who have some infection at the exit sites. To achieve successful BTB, some attention should be made in Nipro-LVAD surgery. For instance, the heart and the outflow vascular graft should be covered with expanded polytetrafluoroethylene (ePTFE) sheet for next safe redo-sternotomy, and the inflow and outflow conduits should be placed appropriately to prevent infection at exit sites. In addition, several examinations and consultation for approval as a heart transplantation recipient should be scheduled as soon as possible after Nipro-LVAD implantation.
authors.affiliation: Department of Cardiothoracic Surgery, The University of Tokyo, Tokyo, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Kinoshita
authors.forename: Minoru
authors.initials: M
authors.lastname: Ono
mesh_terms: D005112:Extracorporeal Circulation; D006333:Heart Failure / Q000601:surgery; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D019736:Prostheses and Implants; D012086:Reoperation