Ono M, Nishimura T, Kinoshita O, Shiga T, Kinugawa K, Nagai R, Kyo S
Department of Cardiac Surgery, University of Tokyo, Tokyo, Japan.
Transplant Proc. 2013 Jun;45(5):2017-8. doi: 10.1016/j.transproceed.2013.01.005.
Contemporary continuous-flow ventricular assist devices (CFVADs) have greatly improved patient survival for indications of bridge to transplantation (BTT) and destination therapy. In Japan, CFVAD is limited for BTT use. The waiting period for heart transplantation (HT) is long owing to donor shortage. We examined the results of CFVAD for BTT indication.
Eighty-nine VAD treatments were performed among subjects whose preimplantation condition was profile 1 (n = 49) or profile 2 or 3 (n = 40). The device was the paracorporeal pulsatile Nipro VAD (n = 67) or CFVAD (n = 22). All CFVAD patients were profile 2 or 3.
The median assist period was 529 days (Nipro VAD, 530; CFVAD, 528). Twenty-six patients were on the device for >2 years. Actuarial survival was 81.6%, 69.5%, and 61.1% at 1, 3, and 5 years. Survival in profile 1 was significantly worse than in profile 2 or 3. Survival of CFVAD patients was superior to that of paracorporeal VAD. Six-month mortality rate of 20% in cases before 2009 (n = 60) was dramatically improved to 3% among those after 2010 (n = 29). All patients with CFVAD were alive and discharged home. 26 patients were transplanted, 7 had been weaned from VAD and 27 were on a device. The rate of events requiring hospital admission was 0.98 per patient-year in CFVAD patients.
Contemporary CFVADs have enabled advanced heart failure patients to await HT safely with an improved quality of life. The advent of CFVAD has also shifted their preimplantation condition to a less sick status. CFVADs were the safest, most reliable circulatory support devices for long-term waiting periods for the BTT indications.
当代连续流心室辅助装置（CFVAD）已显著提高了用于桥接移植（BTT）和终末期治疗适应症患者的生存率。在日本，CFVAD仅限于用于BTT。由于供体短缺，心脏移植（HT）的等待期很长。我们研究了CFVAD用于BTT适应症的结果。
在植入前状况为1型（n = 49）或2型或3型（n = 40）的受试者中进行了89次VAD治疗。使用的装置为体外搏动性日机装VAD（n = 67）或CFVAD（n = 22）。所有CFVAD患者均为2型或3型。
中位辅助期为529天（日机装VAD为530天；CFVAD为528天）。26例患者使用该装置超过2年。1年、3年和5年的精算生存率分别为81.6%、69.5%和61.1%。1型患者的生存率明显低于2型或3型患者。CFVAD患者的生存率优于体外VAD患者。2009年前病例（n = 60）的6个月死亡率为20%，在2010年后的病例（n = 29）中显著改善至3%。所有CFVAD患者均存活并出院回家。26例患者接受了移植，7例已脱离VAD，27例仍在使用装置。CFVAD患者因事件需住院的发生率为每人每年0.98次。
当代CFVAD使晚期心力衰竭患者能够安全等待HT，生活质量得到改善。CFVAD的出现也使他们植入前的状况转变为病情较轻的状态。对于BTT适应症的长期等待期，CFVAD是最安全、最可靠的循环支持装置。
