[Long-term Management of Implantable Left Ventricular Assist Device for Maintaining Quality of Life].

Abstract

The outcomes of implantable left ventricular assist device( iVAD) treatment in Japan are favorable; however, the high rate of re-hospitalization due to complications remains a significant issue. This report details the procedures for iVAD treatment conducted at our hospital. Specifically, we focus on:1. driveline( DL) infection, 2. stroke, and 3. right heart failure. 1. As part of DL infection control, the DL was assumed to enter through the upper umbilicus, and an incision was made from the right side, passing through the left rectus abdominis muscle to the left side. All patients are treated with a simple omental covering, and a new disinfectant, Prontosan, which contains both a surfactant and an antibacterial agent, is used to manage exit site infections involving biofilm. 2. To prevent stroke, all patients are provided with a CoaguChek XS device at discharge, which is adjusted to extend the time required to reach target prothrombin time-international normalized ratio (PT-INR) values. 3. As an innovative approach to treating right heart failure, we have developed a simple or unidirectional valved anastomosis between the superior vena cava and the right pulmonary artery, allowing blood to flow into the pulmonary artery under elevated venous pressure. This procedure is part of a collaborative research project with the School of Science and Engineering at Waseda University( TWIns).