title: Early postoperative management of heart transplant recipients with current ventricular assist device support in Japan: experience from a single center.
abstract: OBJECTIVE
  This study reviews our experience with the perioperative management of heart transplant (HT) recipients and explores how prior ventricular assist device (VAD) support affects the requirements for postoperative mechanical ventilation and circulatory support.
  
  
  RESULTS
  A retrospective database review was performed from 2007 to 2014. Early postoperative outcomes were compared between VAD and non-VAD groups. Forty-four patients were studied. The mean age was 38 ± 13 years, 30% were female, and 88% experienced non-ischemic heart failure. Forty patients (91%) required VAD support at the time of HT, with a mean duration of 864 ± 351 days. The median postoperative mechanical ventilation times in the VAD and non-VAD groups were 54 [95% confidence interval (CI) 42.9-297.3] and 15 (95% CI 4.8-30.0; p = 0.0199) hours, respectively. The VAD group experienced increased bleeding during the first 48 h after HT (6.7 ± 3.5 vs. 1.8 ± 0.75 l, p = 0.004). Mechanical circulatory support with intra-aortic balloon pumping or venoarterial extracorporeal membrane oxygenation was required in 30% of VAD group patients. Increased bleeding and primary graft failure were the main causes of prolonged mechanical ventilation.
  
  
  CONCLUSIONS
  HT recipients with VAD support required longer mechanical ventilation periods and mechanical circulatory support in the postoperative period.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Graduate School of Medicine, Osaka University, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan.
authors.forename: Yu
authors.initials: Y
authors.lastname: Matsumoto
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Graduate School of Medicine, Osaka University, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan. karlshibata@pain.med.osaka-u.ac.jp.
authors.forename: Sho C
authors.initials: SC
authors.lastname: Shibata
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Graduate School of Medicine, Osaka University, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Maeda
authors.affiliation: Department of Cardiovascular Surgery, Graduate School of Medicine, Osaka, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Yoshioka
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Graduate School of Medicine, Osaka University, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan.
authors.forename: Takahiko
authors.initials: T
authors.lastname: Kamibayashi
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Graduate School of Medicine, Osaka University, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan.
authors.forename: Akinori
authors.initials: A
authors.lastname: Uchiyama
authors.affiliation: Department of Cardiovascular Surgery, Graduate School of Medicine, Osaka, Japan.
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Sawa
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Graduate School of Medicine, Osaka University, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Fujino
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000209:etiology; D016027:Heart Transplantation / Q000379:methods*; D006353:Heart-Assist Devices; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D012121:Respiration, Artificial / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Heart transplant; Japan; Perioperative care; Ventricular assist device