[Current State of Right Heart Failure after Implantable Ventricular Assist Device].

Abstract

Japanese registry for Mechanically Assisted Circulatory Support (J-MACS) reports on the results of implantable ventricular assist devices (VADs) in Japan show that the survival rates have stabilized at 93% at one year, 90% at two years and 81% at four years. However, the incidence of neurological dysfunction, hemorrhage and infection, the three major complications, has not been resolved, although it has decreased. Right heart failure has also been improved by implantable left VAD (iLVAD) in patients with preoperative biventricular failure. The J-MACS reported right heart failure free rates of 95% at 90 days, 92% at one year, 90% at two years and 84% at four years. Most cases are in the acute phase after iLVAD and often improve with nitric oxide( NO), drugs or a temporary right VAD( RVAD). In Japan, the waiting period for heart transplantation is long due to the shortage of donors, and the period of RVAD support is much longer than in the West. Right heart failure is sometimes observed in the remote period after iLVAD. Severe cases requiring RVAD and biventricular assist device( BiVAD) are treated with early cardiac transplantation in Europe and the United States of America (USA), while cases requiring long-term BiVAD therapy are extremely rare. Therefore, there are currently no clear standards for the indications and management of RVAD. In this report, we discuss domestic and foreign reports on right heart failure after left VAD (LVAD) and report a valuable case in which RVAD was performed three and a half years after iLVAD in our department, and BiVAD management was required for more than one year for heart transplantation.