[Bridge to bridge surgery;conversion from extracorporeal left ventricular assist device to implantable left ventricular assist device].

Implantable left ventricular assist devices(I-LVADs)are approved only for bridge to transplantation (BTT) in the Japanese health insurance system, and paracorporeal Nipro-LVAD is the only one therapeutic choice for bridge to decision( BTD) and bridge to candidacy(BTC).Destination therapy(DT)with an I-LVAD is also not approved in Japan yet. Because average waiting period for heart transplantation is over 2 years, bridge to bridge( BTB) surgery, conversion from Nipro-LVAD to an I-LVAD, is often considered after the patient with Nipro-LVAD is approved by the committee as a heart transplantation recipient. Infection at the exit sites of Nipro-LVAD is a strong risk factor for pump pocket infection after BTB, and therefore BTB is not recommended for patients with Nipro-LVAD who have some infection at the exit sites. To achieve successful BTB, some attention should be made in Nipro-LVAD surgery. For instance, the heart and the outflow vascular graft should be covered with expanded polytetrafluoroethylene (ePTFE) sheet for next safe redo-sternotomy, and the inflow and outflow conduits should be placed appropriately to prevent infection at exit sites. In addition, several examinations and consultation for approval as a heart transplantation recipient should be scheduled as soon as possible after Nipro-LVAD implantation.