The Experts below are selected from a list of 177 Experts worldwide ranked by ideXlab platform
Yoshiki Sawa - One of the best experts on this subject based on the ideXlab platform.
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initial experience of conversion of Toyobo paracorporeal left ventricular assist device to duraheart left ventricular assist device
Japanese Circulation Journal-english Edition, 2012Co-Authors: Daisuke Yoshioka, Taichi Sakaguchi, Shunsuke Saito, Shigeru Miyagawa, Hiroyuki Nishi, Yasushi Yoshikawa, Satsuki Fukushima, Takayoshi Ueno, Toru Kuratani, Yoshiki SawaAbstract:Background: This report details experience of the conversion of the Toyobo left ventricular assist device (LVAD; Nipro, Osaka, Japan) to the DuraHeart LVAD (TerumoHeart, Ann Arbor, MI, USA) in patients awaiting heart transplantation. Methods and Results: Eight patients (4 male, 4 female) with Toyobo paracorporeal LVAD underwent conversion to the third-generation centrifugal (DuraHeart) LVAD. The apical cuff of the Toyobo was not exchanged because the size was the same as that of the DuraHeart. All conversion operations were performed safely, but 3 patients who had infection of the Toyobo LVAD cannulation site prior to conversion suffered later pocket infections and 1 patient died because of sepsis. One patient underwent heart transplantation and 6 of 8 patients were awaiting heart transplantation at home. Conclusions: Conversions from the Toyobo LVAD to the DuraHeart LVAD were performed safely. Considering that implantable LVADs provide superior long-term survival and quality of life, conversion is a reasonable decision for Toyobo LVAD users in whom there are no infections. (Circ J 2012; 76: 372-376)
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successful bridge to recovery in a patient surviving fatal device related complications after implantation of a Toyobo left ventricular assist system
Journal of Artificial Organs, 2011Co-Authors: Gengo Sunagawa, Takashi Yamauchi, Takafumi Masai, Koji Takeda, Masaru Ishida, Yoshiki SawaAbstract:Emergent left ventricular assist system (LVAS) removal due to device complication is associated with high morbidity and mortality. This report describes a case of a 51-year-old man with dilated cardiomyopathy who successfully underwent emergent LVAS removal after a device-related complication. Although the patient’s left ventricular function was still compromised, LVAS removal was indicated secondary to cerebral hemorrhage. Fortunately, the patient had an uneventful course over the ensuing 8 months and maintained good quality of life.
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risk factor analysis of long term support with left ventricular assist system
Circulation, 2010Co-Authors: Shunsuke Saito, Taichi Sakaguchi, Shigeru Miyagawa, Yasushi Yoshikawa, Toru Kuratani, Goro Matsumiya, Takashi Yamauchi, Yoshiki SawaAbstract:Background: This study was designed to elucidate the key factors for successful long-term support with a left ventricular assist system (LVAS) in the situation where heart transplantation is rarely available. Methods and Results: From 1992 to 2008, 106 patients underwent 121 LVAS implantations at Osaka University Hospital (Toyobo: 77; Novacor: 18; HeartMate: 14; Jarvik2000: 8; EvaHeart: 2; DuraHeart: 2). Risk factors for infection were early on the former implanted period (odds ratio (OR) 3.30), Toyobo (OR 2.25), mechanical right heart support (OR 2.30) and cardiopulmonary bypass time (OR 1.01). Left atrium as the inflow site was the risk factor for cerebrovascular events (OR 2.84). Older age (OR 1.04) and mechanical right heart support (OR 4.70) were risk factors for mortality. Risk factors for requiring mechanical right heart support were preoperative extracorporeal membranous oxygenation support (OR 5.641), serum total bilirubin (OR 1.11) and serum creatinine (OR 2.46). On the basis of the risk analysis for mortality, patients were divided into 2 subgroups (low and high risk) and the respective cumulative survival at 1 year after LVAS implantation was 75.2% and 25.0%. Conclusions: Appropriate selection of device, patient and the timing of implantation and less invasive operation are important for successful long-term LVAS support. (Circ J 2010; 74: 715-722)
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Fifteen-year experience with Toyobo paracorporeal left ventricular assist system
Journal of Artificial Organs, 2009Co-Authors: Shunsuke Saito, Taichi Sakaguchi, Toru Kuratani, Goro Matsumiya, Tomoyuki Fujita, Hajime Ichikawa, Yoshiki SawaAbstract:Our 15-year experience of the Toyobo paracorporeal left ventricular assist system (LVAS) at Osaka University Hospital was reviewed. In total, 61 patients underwent Toyobo LVAS implantation from January 1992 to August 2007. Their mean age was 38.1 ± 16.9 years. The etiologies of heart failure were idiopathic dilated cardiomyopathy in 35 patients, ischemic cardiomyopathy in 15, myocarditis in 5, secondary cardiomyopathy in 4, and others in 2. Preoperatively, intubation was required in 41 patients (67.3%), an intra-aortic balloon pump was required in 38 (62.3%), and extracorporeal membrane oxygenation was required in 30 (49.2%). Four patients underwent heart transplantation and 11 underwent LVAS removal. Of those 11 patients, 4 were subjected to emergent removal because of device complications and all of them died. Of the 7 patients that underwent scheduled LVAS removal, heart failure recurred in 2 patients and reimplantation was required. In terms of major device-related complications, cerebral hemorrhage occurred in 16 patients (26.2%), cerebral infarction in 19 (31.1%), mediastinitis in 10 (16.4%), and inflow/outflow cannula exit site infection in 19 patients (31.1%). The actuarial survival rate of the patients operated on in the last 5 years of this study was 66.3% at 6 months and 45.9% at 1 year. Although the survival rate of patients supported by the Toyobo LVAS has recently improved, the morbidity rate is significant. Considering the current severe shortage of heart donors in Japan, it is important to introduce more durable devices with fewer complications and to establish the strategies for using the LVAS as a bridge to recovery.
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clinical experience with long term use of the Toyobo left ventricular assist system
Asaio Journal, 1995Co-Authors: Takafumi Masai, Yoshiki Sawa, Yuji Miyamoto, Yasuhisa Shimazaki, Keishi Kadoba, Akihiko Yagura, Hikaru Matsuda, Masaki Satoh, S KashiwabaraAbstract:The Toyobo-NCVC extracorporeal pneumatic left ventricular assist system (LVAS) was used in four patients with advanced dilated cardiomyopathy. The duration of support ranged from 46 to 390 days (mean, 206 days). In all patients, stable hemodynamics were achieved with 3.5-5.5 L/min flow rates. Two patients survived long term. One was transported to the United States by a chartered jet while on LVAS and successfully underwent heart transplantation after 119 days of support. The other is on LVAS and is doing well for 390 days. The remaining two patients died of multi-organ failure while their hemodynamics were quite stable under LVAS. In these two patients, severe hepatic failure had developed before LVAS implantation. Minor cerebral embolisms occurred in the two survivors, but neither of them experienced permanent neurologic deficits. In only the initial patient were major thrombi noted on the diaphragm of the pump; the thrombi required pump exchange four times during 119 days. In the patient supported for 390 days, a small tear in the diaphragm was observed after 209 days of support, and the pump was safely exchanged. It is suggested that the Toyobo LVAS can provide consistent and reliable performance for long-term use.
Shunei Kyo - One of the best experts on this subject based on the ideXlab platform.
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new era for therapeutic strategy for heart failure destination therapy by left ventricular assist device
Journal of Cardiology, 2012Co-Authors: Shunei Kyo, Satoshi Gojo, Takashi Nishimura, Taishi Minami, Minoru OnoAbstract:Summary Until 2010, Japan had been using the Toyobo (Nipro, Osaka, Japan) extracorporeal left ventricular assist device (VAD) developed 30 years ago as a 2–3 year bridge to transplantation (BTT). In contrast, western nations started to use implantable VADs in the 1980s that allow in-home care as destination therapy (DT) as well as BTT. Designated in 2007 as “medical devices in high demand,” the 5 major implantable mechanical hearts are smoothly undergoing clinical testing. The HeartMate XVE (Thoratec Corp., Pleasanton, CA, USA) gained approval from the Ministry of Health in November of 2009, the DuraHeart (TerumoHeart, Ann Arbor, MI, USA) and EVAHEART (Sun Medical, Nagano, Japan) in December 2010, and obtained formal insurance reimbursement in April 2011. The Jarvik 2000 (Jarvik Heart Inc., New York, NY, USA) and HeartMate II (Thoratec) VADs are pending approval. On the other hand, the organ transplantation law allowing explantation of donor organs from brain-dead patients finally passed in July 2009 and was realized in July 2010. This law paved the way to pediatric heart transplants as well as a dramatic increase in overall organ transplantation cases. Because many juvenile patients awaiting donor organs need a VAD as a long-term bridge, development and clinical introduction of pediatric VADs capable of implantation is an exigency. Although expectations for transplants are high, the donor numbers are low. Therefore, the demand for implantable VADs capable of long-term home treatment is extremely high in Japan.
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age and preoperative total bilirubin level can stratify prognosis after extracorporeal pulsatile left ventricular assist device implantation
Circulation, 2011Co-Authors: Taro Shiga, Masaru Hatano, Koichiro Kinugawa, Naoko Kato, Miyoko Endo, Takashi Nishimura, Yasunobu Hirata, Shunei Kyo, Atsushi Yao, Minoru OnoAbstract:Background: In Japan, the Toyobo left ventricular assist device (LVAD) has been commercially available for heart failure patients as of 2010, but clinical risk stratification before implantation has not been widely performed. Methods and Results: In the present study data from 47 patients (age 38.6±14.6 [SD] years, male 74.5%, non-ischemic 74.5%) implanted with a Toyobo LVAD between November 2002 and February 2010 were analyzed. Kaplan-Meier survival analysis showed significantly higher mortality in the patients who had cardiogenic shock preoperatively (P=0.031). Multivariate analysis revealed that the preoperative total bilirubin level (odds ratio [OR] 1.312, P<0.001) and age (OR 1.076, P=0.013) were independent risk factors for death. Perioperative necessity of a right ventricular assist device was also an independent risk factor for poor prognosis. Conclusions: LVAD implantation is preferable before the patient experiences hemodynamic collapse. The preoperative total bilirubin level can be used to predict prognosis after device implantation in end-stage heart failure patients. (Circ J 2011; 75: 121-128)
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Thrombotic occlusion of the ascending aorta after Toyobo LVAD implantation with descending aortic perfusion in a post-Bentall patient
Journal of Artificial Organs, 2010Co-Authors: Kan Nawata, Motoyuki Hisagi, Takashi Nishimura, Osamu Kinoshita, Noboru Motomura, Shunei Kyo, Aya Saito, Shinichi Takamoto, Minoru OnoAbstract:A 35-year-old patient in whom a Toyobo left ventricular assist device (LVAD) was implanted with descending aortic perfusion for the treatment of critical heart failure due to global myocardial infarction after repeat aortic root operations with a mechanical aortic valve developed complete thrombotic occlusion of the ascending aorta. This phenomenon was supposedly brought about by the patient’s left ventricular contraction being too poor to open the mechanical aortic valve. The patient has, however, been doing well under LVAD support, with no thromboembolic events occurring for at least 2 years since the device was implanted.
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stomach pierced by apical cuff late after removal of Toyobo assist device
Asian Cardiovascular and Thoracic Annals, 2010Co-Authors: Kan Nawata, Noboru Motomura, Shunei Kyo, Minoru Ono, Shinichi TakamotoAbstract:A 38-year-old woman suffering from dilated cardiomyopathy underwent successful removal of a Toyobo left ventricular assist device after 11 months of support. Four months later, discharge of pus from the skin resulted from the contaminated residual apical cuff. The purulence stopped spontaneously 16 months later, but halitosis then developed. Two weeks later, fever and hematemesis occurred. Emergency surgery revealed gastric perforation by the apical cuff, which was removed under cardiopulmonary bypass.
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bridge to transplantation with a Toyobo ncvc left ventricular assist device in a 3 year old girl
The Japanese Journal of Thoracic and Cardiovascular Surgery, 2008Co-Authors: Ayumu Masuoka, Takashi Nishimura, Toshiyuki Katogi, Mika Iwazaki, Toshiki Kobayashi, Shunei KyoAbstract:In Japan, no pulsatile ventricular assist devices are available specifically for use in children. Pumps designed for adults are thus often used in children. We report herein a case of end-stage heart failure in a 3-yearold girl (height 100.4 cm; body weight 16.2 kg; body surface area 0.66 m2) who underwent implantation with an adult-sized Toyobo-NCVC left ventricular assist device (Toyobo-National Cardiovascular Center, Osaka, Japan) in our unit. We started with the driving mode to “full-fill, full-empty” mode. The problem was difficult-to-treat hypertension due to excessive stroke volume induced by the left ventricular assist device. Aggressive administration of antihypertensive therapy was needed. Successful heart transplantation was performed in Germany 5 months after beginning support with the Toyobo-NCVC left ventricular assist device.
Shunsuke Saito - One of the best experts on this subject based on the ideXlab platform.
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initial experience of conversion of Toyobo paracorporeal left ventricular assist device to duraheart left ventricular assist device
Japanese Circulation Journal-english Edition, 2012Co-Authors: Daisuke Yoshioka, Taichi Sakaguchi, Shunsuke Saito, Shigeru Miyagawa, Hiroyuki Nishi, Yasushi Yoshikawa, Satsuki Fukushima, Takayoshi Ueno, Toru Kuratani, Yoshiki SawaAbstract:Background: This report details experience of the conversion of the Toyobo left ventricular assist device (LVAD; Nipro, Osaka, Japan) to the DuraHeart LVAD (TerumoHeart, Ann Arbor, MI, USA) in patients awaiting heart transplantation. Methods and Results: Eight patients (4 male, 4 female) with Toyobo paracorporeal LVAD underwent conversion to the third-generation centrifugal (DuraHeart) LVAD. The apical cuff of the Toyobo was not exchanged because the size was the same as that of the DuraHeart. All conversion operations were performed safely, but 3 patients who had infection of the Toyobo LVAD cannulation site prior to conversion suffered later pocket infections and 1 patient died because of sepsis. One patient underwent heart transplantation and 6 of 8 patients were awaiting heart transplantation at home. Conclusions: Conversions from the Toyobo LVAD to the DuraHeart LVAD were performed safely. Considering that implantable LVADs provide superior long-term survival and quality of life, conversion is a reasonable decision for Toyobo LVAD users in whom there are no infections. (Circ J 2012; 76: 372-376)
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risk factor analysis of long term support with left ventricular assist system
Circulation, 2010Co-Authors: Shunsuke Saito, Taichi Sakaguchi, Shigeru Miyagawa, Yasushi Yoshikawa, Toru Kuratani, Goro Matsumiya, Takashi Yamauchi, Yoshiki SawaAbstract:Background: This study was designed to elucidate the key factors for successful long-term support with a left ventricular assist system (LVAS) in the situation where heart transplantation is rarely available. Methods and Results: From 1992 to 2008, 106 patients underwent 121 LVAS implantations at Osaka University Hospital (Toyobo: 77; Novacor: 18; HeartMate: 14; Jarvik2000: 8; EvaHeart: 2; DuraHeart: 2). Risk factors for infection were early on the former implanted period (odds ratio (OR) 3.30), Toyobo (OR 2.25), mechanical right heart support (OR 2.30) and cardiopulmonary bypass time (OR 1.01). Left atrium as the inflow site was the risk factor for cerebrovascular events (OR 2.84). Older age (OR 1.04) and mechanical right heart support (OR 4.70) were risk factors for mortality. Risk factors for requiring mechanical right heart support were preoperative extracorporeal membranous oxygenation support (OR 5.641), serum total bilirubin (OR 1.11) and serum creatinine (OR 2.46). On the basis of the risk analysis for mortality, patients were divided into 2 subgroups (low and high risk) and the respective cumulative survival at 1 year after LVAS implantation was 75.2% and 25.0%. Conclusions: Appropriate selection of device, patient and the timing of implantation and less invasive operation are important for successful long-term LVAS support. (Circ J 2010; 74: 715-722)
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Fifteen-year experience with Toyobo paracorporeal left ventricular assist system
Journal of Artificial Organs, 2009Co-Authors: Shunsuke Saito, Taichi Sakaguchi, Toru Kuratani, Goro Matsumiya, Tomoyuki Fujita, Hajime Ichikawa, Yoshiki SawaAbstract:Our 15-year experience of the Toyobo paracorporeal left ventricular assist system (LVAS) at Osaka University Hospital was reviewed. In total, 61 patients underwent Toyobo LVAS implantation from January 1992 to August 2007. Their mean age was 38.1 ± 16.9 years. The etiologies of heart failure were idiopathic dilated cardiomyopathy in 35 patients, ischemic cardiomyopathy in 15, myocarditis in 5, secondary cardiomyopathy in 4, and others in 2. Preoperatively, intubation was required in 41 patients (67.3%), an intra-aortic balloon pump was required in 38 (62.3%), and extracorporeal membrane oxygenation was required in 30 (49.2%). Four patients underwent heart transplantation and 11 underwent LVAS removal. Of those 11 patients, 4 were subjected to emergent removal because of device complications and all of them died. Of the 7 patients that underwent scheduled LVAS removal, heart failure recurred in 2 patients and reimplantation was required. In terms of major device-related complications, cerebral hemorrhage occurred in 16 patients (26.2%), cerebral infarction in 19 (31.1%), mediastinitis in 10 (16.4%), and inflow/outflow cannula exit site infection in 19 patients (31.1%). The actuarial survival rate of the patients operated on in the last 5 years of this study was 66.3% at 6 months and 45.9% at 1 year. Although the survival rate of patients supported by the Toyobo LVAS has recently improved, the morbidity rate is significant. Considering the current severe shortage of heart donors in Japan, it is important to introduce more durable devices with fewer complications and to establish the strategies for using the LVAS as a bridge to recovery.
Takashi Nishimura - One of the best experts on this subject based on the ideXlab platform.
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new era for therapeutic strategy for heart failure destination therapy by left ventricular assist device
Journal of Cardiology, 2012Co-Authors: Shunei Kyo, Satoshi Gojo, Takashi Nishimura, Taishi Minami, Minoru OnoAbstract:Summary Until 2010, Japan had been using the Toyobo (Nipro, Osaka, Japan) extracorporeal left ventricular assist device (VAD) developed 30 years ago as a 2–3 year bridge to transplantation (BTT). In contrast, western nations started to use implantable VADs in the 1980s that allow in-home care as destination therapy (DT) as well as BTT. Designated in 2007 as “medical devices in high demand,” the 5 major implantable mechanical hearts are smoothly undergoing clinical testing. The HeartMate XVE (Thoratec Corp., Pleasanton, CA, USA) gained approval from the Ministry of Health in November of 2009, the DuraHeart (TerumoHeart, Ann Arbor, MI, USA) and EVAHEART (Sun Medical, Nagano, Japan) in December 2010, and obtained formal insurance reimbursement in April 2011. The Jarvik 2000 (Jarvik Heart Inc., New York, NY, USA) and HeartMate II (Thoratec) VADs are pending approval. On the other hand, the organ transplantation law allowing explantation of donor organs from brain-dead patients finally passed in July 2009 and was realized in July 2010. This law paved the way to pediatric heart transplants as well as a dramatic increase in overall organ transplantation cases. Because many juvenile patients awaiting donor organs need a VAD as a long-term bridge, development and clinical introduction of pediatric VADs capable of implantation is an exigency. Although expectations for transplants are high, the donor numbers are low. Therefore, the demand for implantable VADs capable of long-term home treatment is extremely high in Japan.
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prolonged biventricular assist device support as a bridge to heart transplantation
Journal of Artificial Organs, 2011Co-Authors: Chitaru Kurihara, Motoyuki Hisagi, Takashi Nishimura, Kan Nawata, Osamu Kinoshita, Noboru MotomuraAbstract:We report a case in which long-term biventricular assist device (BiVAD) support enabled successful heart transplantation. The patient was diagnosed with dilated cardiomyopathy at age 11. She underwent implantation of a Toyobo LVAD, tricuspid valvuloplasty and annuloplasty at age 15. Right heart bypass (RHB) was established using a centrifugal pump. Right ventricular function showed no improvement during a ten-day period, and RHB was switched to a Toyobo RVAD on postoperative day (POD) 11. Because of poor oxygenation, veno-venous extracorporeal membrane oxygenation (V–V ECMO) was instituted. She was weaned from V–V ECMO on POD 14. She was brought to the United States on POD 189 under BiVAD support, and underwent heart transplantation on POD 199. She was discharged 4 months later. Two years after heart transplantation, she remained in New York Heart Association class one without rejection.
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less frequent opening of the aortic valve and a continuous flow pump are risk factors for postoperative onset of aortic insufficiency in patients with a left ventricular assist device
Circulation, 2011Co-Authors: Masaru Hatano, Koichiro Kinugawa, Taro Shiga, Naoko Kato, Miyoko Endo, Motoyuki Hisagi, Takashi Nishimura, Yasunobu Hirata, Ryozo NagaiAbstract:Background: Postoperative development of aortic insufficiency (AI) after implantation of left ventricular assist devices (LVADs) has recently been recognized, but the devices in the previous reports have been limited to the HeartMate I or II. The purposes of this study were to determine whether AI develops with other types of LVADs and to elucidate the factors associated with the development of AI. Methods and Results: Thirty-seven patients receiving LVADs without evident abnormalities in native aortic valves were enrolled (pulsatile flow LVAD [Toyobo]: 76%, continuous flow LVAD [EVAHEART, DuraHeart, Jarvik2000, HeartMate II]: 24%). Frequency of aortic valve opening and grade of AI were evaluated by the most recent echocardiography during LVAD support. None of the patients had more than trace AI preoperatively. During LVAD support AI >- grade 2 developed in 9 patients (24%) across all 5 types of devices. More severe grade of AI correlated with higher plasma B-type natriuretic peptide concentration (r=0.53, P<0.01) and with less frequent of the aortic valve (r=0.45, P<0.01). Multivariate analysis revealed that lower preoperative left ventricular ejection fraction and a continuous flow device type were independent risk factors for higher incidence of AI. Conclusions: AI, which is hemodynamically significant, develops after implantation of various types of LVADs. Physicians need to be more alert to the development of AI particularly with continuous flow devices. (Circ J 2011; 75: 1147-1155)
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age and preoperative total bilirubin level can stratify prognosis after extracorporeal pulsatile left ventricular assist device implantation
Circulation, 2011Co-Authors: Taro Shiga, Masaru Hatano, Koichiro Kinugawa, Naoko Kato, Miyoko Endo, Takashi Nishimura, Yasunobu Hirata, Shunei Kyo, Atsushi Yao, Minoru OnoAbstract:Background: In Japan, the Toyobo left ventricular assist device (LVAD) has been commercially available for heart failure patients as of 2010, but clinical risk stratification before implantation has not been widely performed. Methods and Results: In the present study data from 47 patients (age 38.6±14.6 [SD] years, male 74.5%, non-ischemic 74.5%) implanted with a Toyobo LVAD between November 2002 and February 2010 were analyzed. Kaplan-Meier survival analysis showed significantly higher mortality in the patients who had cardiogenic shock preoperatively (P=0.031). Multivariate analysis revealed that the preoperative total bilirubin level (odds ratio [OR] 1.312, P<0.001) and age (OR 1.076, P=0.013) were independent risk factors for death. Perioperative necessity of a right ventricular assist device was also an independent risk factor for poor prognosis. Conclusions: LVAD implantation is preferable before the patient experiences hemodynamic collapse. The preoperative total bilirubin level can be used to predict prognosis after device implantation in end-stage heart failure patients. (Circ J 2011; 75: 121-128)
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Thrombotic occlusion of the ascending aorta after Toyobo LVAD implantation with descending aortic perfusion in a post-Bentall patient
Journal of Artificial Organs, 2010Co-Authors: Kan Nawata, Motoyuki Hisagi, Takashi Nishimura, Osamu Kinoshita, Noboru Motomura, Shunei Kyo, Aya Saito, Shinichi Takamoto, Minoru OnoAbstract:A 35-year-old patient in whom a Toyobo left ventricular assist device (LVAD) was implanted with descending aortic perfusion for the treatment of critical heart failure due to global myocardial infarction after repeat aortic root operations with a mechanical aortic valve developed complete thrombotic occlusion of the ascending aorta. This phenomenon was supposedly brought about by the patient’s left ventricular contraction being too poor to open the mechanical aortic valve. The patient has, however, been doing well under LVAD support, with no thromboembolic events occurring for at least 2 years since the device was implanted.
Taichi Sakaguchi - One of the best experts on this subject based on the ideXlab platform.
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initial experience of conversion of Toyobo paracorporeal left ventricular assist device to duraheart left ventricular assist device
Japanese Circulation Journal-english Edition, 2012Co-Authors: Daisuke Yoshioka, Taichi Sakaguchi, Shunsuke Saito, Shigeru Miyagawa, Hiroyuki Nishi, Yasushi Yoshikawa, Satsuki Fukushima, Takayoshi Ueno, Toru Kuratani, Yoshiki SawaAbstract:Background: This report details experience of the conversion of the Toyobo left ventricular assist device (LVAD; Nipro, Osaka, Japan) to the DuraHeart LVAD (TerumoHeart, Ann Arbor, MI, USA) in patients awaiting heart transplantation. Methods and Results: Eight patients (4 male, 4 female) with Toyobo paracorporeal LVAD underwent conversion to the third-generation centrifugal (DuraHeart) LVAD. The apical cuff of the Toyobo was not exchanged because the size was the same as that of the DuraHeart. All conversion operations were performed safely, but 3 patients who had infection of the Toyobo LVAD cannulation site prior to conversion suffered later pocket infections and 1 patient died because of sepsis. One patient underwent heart transplantation and 6 of 8 patients were awaiting heart transplantation at home. Conclusions: Conversions from the Toyobo LVAD to the DuraHeart LVAD were performed safely. Considering that implantable LVADs provide superior long-term survival and quality of life, conversion is a reasonable decision for Toyobo LVAD users in whom there are no infections. (Circ J 2012; 76: 372-376)
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risk factor analysis of long term support with left ventricular assist system
Circulation, 2010Co-Authors: Shunsuke Saito, Taichi Sakaguchi, Shigeru Miyagawa, Yasushi Yoshikawa, Toru Kuratani, Goro Matsumiya, Takashi Yamauchi, Yoshiki SawaAbstract:Background: This study was designed to elucidate the key factors for successful long-term support with a left ventricular assist system (LVAS) in the situation where heart transplantation is rarely available. Methods and Results: From 1992 to 2008, 106 patients underwent 121 LVAS implantations at Osaka University Hospital (Toyobo: 77; Novacor: 18; HeartMate: 14; Jarvik2000: 8; EvaHeart: 2; DuraHeart: 2). Risk factors for infection were early on the former implanted period (odds ratio (OR) 3.30), Toyobo (OR 2.25), mechanical right heart support (OR 2.30) and cardiopulmonary bypass time (OR 1.01). Left atrium as the inflow site was the risk factor for cerebrovascular events (OR 2.84). Older age (OR 1.04) and mechanical right heart support (OR 4.70) were risk factors for mortality. Risk factors for requiring mechanical right heart support were preoperative extracorporeal membranous oxygenation support (OR 5.641), serum total bilirubin (OR 1.11) and serum creatinine (OR 2.46). On the basis of the risk analysis for mortality, patients were divided into 2 subgroups (low and high risk) and the respective cumulative survival at 1 year after LVAS implantation was 75.2% and 25.0%. Conclusions: Appropriate selection of device, patient and the timing of implantation and less invasive operation are important for successful long-term LVAS support. (Circ J 2010; 74: 715-722)
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Fifteen-year experience with Toyobo paracorporeal left ventricular assist system
Journal of Artificial Organs, 2009Co-Authors: Shunsuke Saito, Taichi Sakaguchi, Toru Kuratani, Goro Matsumiya, Tomoyuki Fujita, Hajime Ichikawa, Yoshiki SawaAbstract:Our 15-year experience of the Toyobo paracorporeal left ventricular assist system (LVAS) at Osaka University Hospital was reviewed. In total, 61 patients underwent Toyobo LVAS implantation from January 1992 to August 2007. Their mean age was 38.1 ± 16.9 years. The etiologies of heart failure were idiopathic dilated cardiomyopathy in 35 patients, ischemic cardiomyopathy in 15, myocarditis in 5, secondary cardiomyopathy in 4, and others in 2. Preoperatively, intubation was required in 41 patients (67.3%), an intra-aortic balloon pump was required in 38 (62.3%), and extracorporeal membrane oxygenation was required in 30 (49.2%). Four patients underwent heart transplantation and 11 underwent LVAS removal. Of those 11 patients, 4 were subjected to emergent removal because of device complications and all of them died. Of the 7 patients that underwent scheduled LVAS removal, heart failure recurred in 2 patients and reimplantation was required. In terms of major device-related complications, cerebral hemorrhage occurred in 16 patients (26.2%), cerebral infarction in 19 (31.1%), mediastinitis in 10 (16.4%), and inflow/outflow cannula exit site infection in 19 patients (31.1%). The actuarial survival rate of the patients operated on in the last 5 years of this study was 66.3% at 6 months and 45.9% at 1 year. Although the survival rate of patients supported by the Toyobo LVAS has recently improved, the morbidity rate is significant. Considering the current severe shortage of heart donors in Japan, it is important to introduce more durable devices with fewer complications and to establish the strategies for using the LVAS as a bridge to recovery.
