Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
Circ J. 2013;77(7):1736-41. doi: 10.1253/circj.cj-12-1410. Epub 2013 Apr 18.
The DuraHeart left ventricular assist device (LVAD) is the world's first approved magnetically levitated implantable centrifugal pump. We report our initial experience with the DuraHeart as a bridge to heart transplantation.
Between 2008 and 2011, 23 patients (17 males; mean age 35 years, range 16-53 years) with endstage heart failure underwent implantation with the DuraHeart LVAD at Osaka University Hospital. Of those, 7 underwent conversion surgery from a Nipro paracorporeal LVAD to the DuraHeart. There were no deaths during the mean support period of 559±241 days (176-999 days). In total, 17 patients (74%) remain with the LVAD and 5 (22%) underwent heart transplantation after 580±302 days (176-982 days) of support. Major adverse events included 8 (34%) driveline/pocket infections, 4 (17%) cerebrovascular accidents, 4 (17%) right heart failures requiring mechanical support, and 3 (13%) mechanical device failures (magnetic levitation failure caused by driveline fracture). Of the 5 patients who developed pump pocket infection, 3 underwent previous conversion surgery from the Nipro LVAD.
Our initial experience with the DuraHeart LVAD in Japan demonstrated excellent long-term survival with acceptable rates of adverse events. With refinement of the system, including mechanical durability, this pump will further enhance the quality of life for patients who require long-term mechanical circulatory support.
DuraHeart 左心室辅助装置(LVAD)是世界上首个获准的磁悬浮植入式离心泵。我们报告了使用 DuraHeart 作为心脏移植桥接的初步经验。
2008 年至 2011 年期间,23 名终末期心力衰竭患者在大阪大学医院植入 DuraHeart LVAD。其中 7 名患者从尼普洛体外 LVAD 转换为 DuraHeart。在平均 559±241 天(176-999 天)的支持期间,无死亡。总共有 17 名患者(74%)仍在使用 LVAD,5 名患者(22%)在 580±302 天(176-982 天)的支持后接受了心脏移植。主要不良事件包括 8 例(34%)的导线/囊袋感染、4 例(17%)的脑血管意外、4 例(17%)需要机械支持的右心衰竭和 3 例(13%)的机械装置故障(由导线断裂引起的磁悬浮故障)。在 5 名发生泵囊袋感染的患者中,有 3 名患者曾接受过尼普洛 LVAD 的先前转换手术。
我们在日本使用 DuraHeart LVAD 的初步经验表明,长期生存效果极好,不良事件发生率可接受。随着系统的改进,包括机械耐久性的提高,这种泵将进一步提高需要长期机械循环支持的患者的生活质量。