19 Update of LVAD therapy in japan

Abstract

Left ventricular assist device (LVAD) has been increasingly utilised for the treatment of advanced (ACC/AHA stage D) heart failure. Three types of implantable device (HeartMate IITM, Jarvik 2000®, and EVAHEARTTM) are currently available as a bridge-to-transplant in Japan. J-MACS (Japanese registry for mechanically assisted circulatory support) has listed a total of 722 patients between December 2010 and October 2017. Mean age was 43.2 years and mean body surface area was 1.63 m2. Aetiology of heart failure was dilated cardiomyopathy in 77% and ischaemic cardiomyopathy in 11%. Pre-operative INTERMACS profile was level 1 in 10%, level 2 in 39%, level 3 in 48%, and level 4 or 5 in 4%. One hundred forty-nine (21%) patients received extracorporeal life support device first for cardiogenic shock or bridge-to-candidacy, and then underwent switch to implantable devices (bridge-to-bridge). Overall survival rate after LVAD implantation was 90% at 1 year and 86% at 2 years. Competing outcome analyses demonstrated that only 10% of patients reached heart transplantation and 60% were still on device therapy at 3 years. Causes of death were cerebrovascular accident in 44%, infection in 18%, bleeding in 6%, and device failure in 6%. Sixty-six per cent of patients required at least 1 hospital admission during an initial 1 year after device implantation. In conclusion, continuous flow LVAD was effective for bridge-to-transplant. Although the collected data indicate that the improved survival rate is acceptable, there remains potential for major complications which precludes wider application of LVAD.