Midterm outcome of implantable left ventricular assist devices as a bridge to transplantation: Single-center experience in Japan

Mitsutoshi Kimura; Osamu Kinoshita; Kan Nawata; Takashi Nishimura; Masaru Hatano; Teruhiko Imamura; Miyoko Endo; Yukie Kagami; Hitoshi Kubo; Koichi Kashiwa; Koichiro Kinugawa; Shunei Kyo; Issei Komuro; Minoru Ono

doi:10.1016/j.jjcc.2014.06.007

Midterm outcome of implantable left ventricular assist devices as a bridge to transplantation: Single-center experience in Japan

J Cardiol. 2015 May;65(5):383-9. doi: 10.1016/j.jjcc.2014.06.007. Epub 2014 Jul 14.

Authors

Affiliations

¹ Department of Cardiovascular Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
² 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.
³ Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
⁴ Department of Organ Transplantation, The University of Tokyo Hospital, Tokyo, Japan.
⁵ Department of Medical Engineering, The University of Tokyo Hospital, Tokyo, Japan.
⁶ 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.
⁷ Department of Cardiovascular Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. Electronic address: mono-tky@umin.ac.jp.

PMID: 25034705
DOI: 10.1016/j.jjcc.2014.06.007

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.

Methods and 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.

Keywords: Bridge to transplantation; Heart failure; Implantable left ventricular assist device; Outcome; Readmission.

MeSH terms

Adult
Arrhythmias, Cardiac / epidemiology
Female
Follow-Up Studies
Heart Failure / epidemiology*
Heart Failure / mortality
Heart Failure / therapy*
Heart Transplantation*
Heart-Assist Devices* / adverse effects
Humans
Incidence
Japan / epidemiology
Kaplan-Meier Estimate
Male
Middle Aged
Retrospective Studies
Stroke / epidemiology
Treatment Outcome