ヤマザキ　ケンジ   KENJI YAMAZAKI   山崎　健二    所属   医学部 医学科（東京女子医科大学病院）    職種   客員教授
言語種別	日本語
発表タイトル	Current Status and Perspectives of Left Ventricular Assist Device Therapy
会議名	第81回日本循環器学会学術集会
主催者	日本循環器学会
学会区分	全国規模の学会
発表形式	口頭
発表者・共同発表者	◎山崎健二
発表年月日	2017/03/18
開催地 （都市, 国名）	金沢市
学会抄録	第81回日本循環器学会学術集会　プログラム集 255
概要	*ラウンドテーブルディスカッション 4 重症心不全治療における非薬物学的介入の今後への展望 Continuous‒flow LVADs have played an increasingly important role in the management of patients with end‒stage heart failure. More than 20,000 devices have been implanted worldwide. LVADs have dramatically improved patient prognosis and quality of life; both BTT and DT in US and Europe. Seventh INTERMACS annual report (includes >15,000 patients) described 2500 implants (BTT +DT) in 2014. DT accounts for nearly half of all implants. Overall survival rate at 1 and 2 years is 80% and 70%, respectively. Survival among DT patients (1 year 76%, 2 years 57%) has been worse than among BTT patients. Continuous‒flow LVADs provide marked alterations in normal physiology, high‒shear, less‒pulsed flow, leading to unanticipated adverse effects such as acquired von Willebrand disease and aortic insufficiency. Causes of deaths were 1) neurologic event, 2) multisystem organ failure, 3) withdrawal of support, 4) major infection. Freedom from major adverse events rate was 30% at 1 year. In Japan, more than 600 C‒F LVADs were implanted. The support duration has been extended to over three years due to severe donor shortage. Survival rate was excellent (90% at 2 years), and now DT clinical trial with Heartmate II has started. Evidently LVADs are powerful and effective tools for advanced heart failure management, however, major adverse events rate remains high. Various research and development are currently in progress to improve clinical outcome.