ニシナカ　トモヒロ   Tomohiro Nishinaka   西中　知博    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	Bridge to Transplant Long-term Mechanical Circulatory Support: Current Status and Keys for Preventing Adverse Events.
会議名	第79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	◎西中知博
発表年月日	2015/04/24
開催地 （都市, 国名）	大阪市
概要	*Round Table Discussion 2 Currently long-term mechanical circulatory support is required for bridge to heart transplant with increase of its number. Implantable continuous flow left ventricular assist devices (LVADs) have realized long-term mechanical support, although there are some significant issues to be solved to improve clinical outcomes as well as quality of life of patients. Bleeding and thromboembolism are still most serious adverse events. Anticoagulation therapy, pump, inflow, and outflow conduits structure, management of flow pattern in the left ventricle, and changes of coagulation relating factors are considered to be related and should be clarified how to manage them. Gastrointestinal bleeding is one of serious adverse events, which is considered to be related with changes of von Willebrand factors and reduced pulsatility. Deterioration of aortic valve insufficiency is a crucial problem, although mechanism of it is still controversial. Effect of pulsatility, aortic valve opening, and anatomical design of inflow cannula anastomosis are to be clarified. Driveline infections have a great impact on long-term clinical outcomes. Management of driveline has improved in terms of prevention and treatment recently. However, modification of driveline surface and development of total implantable system are expected to be a fundamental solution. Right heart failure has also a great impact on clinical results. Development of reliable right heart assist device is required, whereas mechanism of developing of right heart failure after LVAD implantation should be examined. In conclusion, the bridge to transplant mechanical circulatory support with continuous flow LVAD has realized long-term survival, while there are still some crucial complications to be solved for improving clinical outcomes.