Risk Factor Analysis of Long-Term Support With Left Ventricular Assist System

Shunsuke Saito; Goro Matsumiya; Taichi Sakaguchi; Shigeru Miyagawa; Yasushi Yoshikawa; Takashi Yamauchi; Toru Kuratani; Yoshiki Sawa

doi:10.1253/circj.CJ-09-0747

Cardiovascular Surgery

Risk Factor Analysis of Long-Term Support With Left Ventricular Assist System

Shunsuke Saito, Goro Matsumiya, Taichi Sakaguchi, Shigeru Miyagawa, Yasushi Yoshikawa, Takashi Yamauchi, Toru Kuratani, Yoshiki Sawa

Author information

Shunsuke Saito
Division of Cardiovascular Surgery, Department of Surgery, Osaka University Graduate School of Medicine
Goro Matsumiya
Division of Cardiovascular Surgery, Department of Surgery, Osaka University Graduate School of Medicine
Taichi Sakaguchi
Division of Cardiovascular Surgery, Department of Surgery, Osaka University Graduate School of Medicine
Shigeru Miyagawa
Division of Cardiovascular Surgery, Department of Surgery, Osaka University Graduate School of Medicine
Yasushi Yoshikawa
Division of Cardiovascular Surgery, Department of Surgery, Osaka University Graduate School of Medicine
Takashi Yamauchi
Division of Cardiovascular Surgery, Department of Surgery, Osaka University Graduate School of Medicine
Toru Kuratani
Division of Cardiovascular Surgery, Department of Surgery, Osaka University Graduate School of Medicine
Yoshiki Sawa
Division of Cardiovascular Surgery, Department of Surgery, Osaka University Graduate School of Medicine

Keywords: Bridge to transplantation, Destination therapy, Left ventricular assist system, Long-term support, Risk analysis

JOURNAL FREE ACCESS

2010 Volume 74 Issue 4 Pages 715-722

DOI https://doi.org/10.1253/circj.CJ-09-0747

View "Advance Publication" version (February 17, 2010).

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Abstract

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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