Clinical experience of left ventricular assist systems at the Heart Institute of Japan.

Abstract

The main indications for left ventricular assist system (LVAS) support are postcardiotomy ventricular failure as temporary circulatory support and end-stage cardiomyopathy as chronic circulatory support. To clarify the efficacy of LVAS support, we assessed the clinical outcome of a pneumatic LVAS and an electromagnetic LVAS for patients with severe ventricular failure. As of March 1998, 5 patients with postcardiotomy ventricular failure had received the pneumatic LVAS support, and 2 other patients with end-stage idiopathic cardiomyopathy had undergone implantation of the electromagnetic LVAS. The drive control of the LVAS was mainly counterpulsation in the diastole of the native heart. In the 5 postcardiotomy patients, the duration of pneumatic LVAS support ranged from 30 to 312 h (mean, 109.2). All 3 patients with more than 72 h support were successfully weaned, and 2 of them survived. The other 2 patients with cardiogenic shock and less than 36 h support could not be weaned from the LVAS. In the 2 cardiomyopathy patients, 1 patient was well maintained by the electromagnetic LVAS support and underwent successful heart transplantation 7 months later. The other patient has been chronically supported by the LVAS for 2 months and is doing well so far. These results suggest that selective application of the pneumatic LVAS as a temporary support and the electromagnetic LVAS as a chronic support might be appropriate for maximizing the effectiveness of LVAS treatment for profound cardiac failure.