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CARDIOVASCULAR
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Volume 5, 2000, No 1 |
Mechanical
Circulatory Assist for Endstage Heart Failure in Tokyo Womens Medical University
M. Hachida, H. Furukawa, H. Koyanagi
Mechanical circulatory assist has been widely used as a bridge to transplantation. However, in Japan, heart trasnplantation has not been started because of lack of donor. The conception for using an assist device was therefore different from other countries. In this study, the application of MCS for the last 7 years was evaluated and the current strategy of MCS was discussed. The devices we applied from 1991 to 1996 were PCPS, biventricular assist using centrifugal pump and domestic artificial heart. Since 1996 clinical trial for Novacor assist device has started. PCPS was predominantly used for the patients, of whom 3 with dilated cardiomyopathy, 1 with broad myocardial infarction and 1 with acute myocarditis. All the patients were candidates for heart transplantation. Their circulatory support time was 44-256 hours (mean 109 hours). During the first 72 hours of the assist, no irreversible hepatic and renal dysfunction was found. One patient survived and was discharged. The other patients who had the assist over 72 hours died with multi-organ failure. Fifteen patients underwent MCS for more than 6 hours following heart operation (mean 22 hours). The types of MCS were biventricular bypass in 8 patients, V-A Bypass in 6 patients and Left ventricular bypass in 1 patient. Centrifugal pump was used in 4 patients. Neither thrombolic problem or multi-organ failure were observed in the first 72 hours. Eight patients successfully weaned from MCS and 3 patients discharged (20%). Prolonged MCS over 72 hours showed no long-term survival. Since 1996, two patients have undergone Novacor implantation. One patient was supported by the device for 6 months and then received heart transplantation at UCLA. Another patient has been doing well for 2 months under Novacor device. In conclusion, our experience demonstrates that the 72 hours of assist might be a limitation for using conventional methods. Novacor implantation may be a solution in case of prolonged assist.
Key words: heart transplantation, artificial heart, Novacor heart, heart failure
Address for Correspondence:
Mitsuhiro Hachida,
M.D.
Second Department of Surgery
University of Occupational and Environmental Health
1-1, Iseigaoka , Yahatanishiku, Kitakyushuw, Fukuoka, 817-8555
Japan
E-mal: hachidam@med.uoeh-u.ac.jp
Reference:
(CVE. 2000; 5 (1): 26-29)
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