title: Midterm outcome of implantable left ventricular assist devices as a bridge to transplantation: Single-center experience in Japan.
abstract: BACKGROUND
  Two implantable continuous-flow left ventricular assist devices (LVADs), DuraHeart (Terumo Heart, Ann Arbor, MI, USA) and EVAHEART (Sun Medical, Nagano, Japan), were approved in Japan in April 2011. We analyzed the midterm outcome of patients implanted with these implantable LVADs at the University of Tokyo Hospital.
  
  
  RESULTS
  A total of 31 patients who underwent implantation of LVADs (10 DuraHeart, 21 EVAHEART) as a bridge to transplantation at our institution between April 2011 and August 2013 were retrospectively reviewed. All patients were followed up through December 2013. Seven patients underwent conversions from NIPRO paracorporeal LVAD (Nipro, Osaka, Japan) to an implantable LVAD. The mean observation period was 483±239 days (41.0 patient years). Eight patients were transplanted and one patient showed functional recovery with subsequent LVAD explantation. Four patients died due to cerebrovascular accident, empyema, or device malfunction due to pump thrombosis after cerebral bleeding. Kaplan-Meier analysis revealed 6-, 12-, and 24-month survival rates of 93%, 86%, and 86%, respectively. The rates of freedom from cerebrovascular accidents and device-related infections at 1 year after LVAD implantation were 65% and 36%, respectively. Twenty-nine patients were discharged home after LVAD implantation. During the period of this study, there were 59 readmissions (53 urgent, 6 elective) among 22 patients (76%). The overall and urgent readmission rates were 1.66 and 1.49 per patient year, respectively. The common reason for readmission was device-related infection (31%), followed by cerebrovascular accidents (17%). The total out-of-hospital time after the primary discharge was 90%.
  
  
  CONCLUSIONS
  Our midterm survival rate after LVAD implantation is satisfactory. However, patients undergoing LVAD support were often readmitted with adverse events.
authors.affiliation: Department of Cardiovascular Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Mitsutoshi
authors.initials: M
authors.lastname: Kimura
authors.affiliation: Department of Cardiovascular Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Kinoshita
authors.affiliation: Department of Cardiovascular Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Kan
authors.initials: K
authors.lastname: Nawata
authors.affiliation: Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Cardiac Surgery, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Nishimura
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Masaru
authors.initials: M
authors.lastname: Hatano
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Teruhiko
authors.initials: T
authors.lastname: Imamura
authors.affiliation: Department of Organ Transplantation, The University of Tokyo Hospital, Tokyo, Japan.
authors.forename: Miyoko
authors.initials: M
authors.lastname: Endo
authors.affiliation: Department of Organ Transplantation, The University of Tokyo Hospital, Tokyo, Japan.
authors.forename: Yukie
authors.initials: Y
authors.lastname: Kagami
authors.affiliation: Department of Medical Engineering, The University of Tokyo Hospital, Tokyo, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Kubo
authors.affiliation: Department of Medical Engineering, The University of Tokyo Hospital, Tokyo, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Kashiwa
authors.affiliation: Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Koichiro
authors.initials: K
authors.lastname: Kinugawa
authors.affiliation: Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Cardiac Surgery, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan.
authors.forename: Shunei
authors.initials: S
authors.lastname: Kyo
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Issei
authors.initials: I
authors.lastname: Komuro
authors.affiliation: Department of Cardiovascular Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. Electronic address: mono-tky@umin.ac.jp.
authors.forename: Minoru
authors.initials: M
authors.lastname: Ono
mesh_terms: D000328:Adult; D001145:Arrhythmias, Cardiac / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy*; D016027:Heart Transplantation; D006353:Heart-Assist Devices / Q000009:adverse effects; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020521:Stroke / Q000453:epidemiology; D016896:Treatment Outcome
keywords: Bridge to transplantation; Heart failure; Implantable left ventricular assist device; Outcome; Readmission