J.Jpn. Surg. Soc.. 121(6): 613-619, 2020

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Feature topic

IMPLANTABLE VENTRICULAR ASSIST DEVICES

Implantable ventricular assist devices are a robust therapy for patients with end-stage heart failure who are eligible for heart transplantation. A rotary pump is implanted in the body, and a drive unit and energy supply kit are managed extracorporeally with a connecting cable (drive line). This integrated system enables patients to be managed at home. Rotary pump systems are classified into centrifugal and axial flow pumps. Centrifugal pumps have comparatively lower rotational speeds and are designed to generate pulse pressure. Axial flow pumps can consist of smaller rotary pump systems and thus require much higher rotational speeds. As waiting lists for heart transplantation are becoming longer, the duration of implantable ventricular assist device management has inevitably been extended markedly. Significant numbers of lethal complications have been documented, including cerebral infarction, cerebral hemorrhage, infection, and bleeding. Other serious complications can also occur, including right heart failure, gastrointestinal bleeding, and de novo aortic regurgitation. Team medical care is essential for improving long-term results. It is necessary to make all possible efforts to prevent and treat complications to improve the long-term prognosis. To that end, multiprofessional conferences are mandatory to offer tailor-made individualized care and management to patients who must receive ventricular assist device therapy.

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