Rescuing Patients With Severe Biventricular Failure in the Era of Continuous-Flow Left Ventricular Assist Device

  • Saito Shunsuke
    Department of Cardiac Surgery, International University of Health and Welfare, School of Medicine
  • Toda Koichi
    Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
  • Nakamura Teruya
    Department of Cardiac Surgery, International University of Health and Welfare, School of Medicine
  • Miyagawa Shigeru
    Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
  • Yoshikawa Yasushi
    Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
  • Hata Hiroki
    Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
  • Yoshioka Daisuke
    Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
  • Kainuma Satoshi
    Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
  • Yoshida Shohei
    Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
  • Sawa Yoshiki
    Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine

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Description

<p>Background: We evaluated clinical outcomes of left ventricular assist device (LVAD) support in patients with or without severe right heart failure, in order to determine what kind of organ allocation system could help severe biventricular failure patients to be safely bridged to heart transplantation (HTx), even in Japan where the waiting time for HTx is extremely long. </p><p>Methods and Results: One hundred and seventy consecutive patients who were implanted with continuous-flow LVAD at the present institution were included in this study. The patients were divided into 2 groups: 158 patients with isolated LVAD (group-LVF) and 12 patients who required long-term mechanical or inotropic right heart support (group-BVF). Post-LVAD survival in group-BVF was significantly worse than in group-LVF (P<0.0001). Given that many patients in group-BVF died between 1 and 2 years after LVAD implantation, Kaplan-Meier survival curve simulation was carried out under the condition that all the patients in group-BVF who died on LVAD support >1 year after LVAD implantation had received HTx at 365 days after LVAD implantation and survived thereafter. In this simulation, no significant difference in survival was seen between the groups (P=0.2424). </p><p>Conclusions: A new allocation system that allows severe right heart failure patients to receive HTx at around 1 year would enable rescue of the patients with severe right heart failure. </p>

Journal

  • Circulation Journal

    Circulation Journal 83 (2), 379-385, 2019-01-25

    The Japanese Circulation Society

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