ニイナミ　ヒロシ   NIINAMI Hiroshi   新浪　博    所属   医学部 医学科（東京女子医科大学病院）    職種   教授・基幹分野長
言語種別	英語
発表タイトル	Evaluation of Hemodynamics of Aortic Insufficiency under LVAD Support
会議名	26th Annual Meeting of the International Society for Mechanical Circulatory Support (ISMCS2018)
主催者	ISMCS2018
学会区分	国際学会及び海外の学会
発表形式	口頭
講演区分	一般
発表者・共同発表者	◎IIZUKA Kei, NISHINAKA Tomohiro, NIINAMI Hiroshi, AKIYAMA Daichi, NAITO Noritsugu, MIZUNO Toshihide, TSUKIYA Tomonori, TAKEWA Yoshiaki, TATSUMI Eisuke
発表年月日	2018/11/02
開催地 （都市, 国名）	Tokyo, JAPAN
学会抄録	Abstract Book 146
概要	Aortic insufficiency (AI) is a worrisome problem under left ventricular assist device (LVAD) support. The factors causing AI were still controversial. We evaluated some clinical questions from basic side. Progressive AI can lead to LVAD-LV recirculation, resulting low-output syndrome. Increasing of rotational speed to solve the low-output was controversial because it could also increase the LVADLV recirculation. We established an animal model of AI with LVAD, and evaluated the hemodynamics with changing rotational speed. It was suggested from experiments with five goats that the increasing of rotational speed did not contribute to improve the output in AI with Sellers classification 3 or more. Progressive AI can need surgical intervention, but the influence of AI progression on hemodynamics was not clarified enough. We evaluated the hemodynamics of AI progression with cardiac dysfunction model of five LVAD-AI goats. Left atrial and ventricular pressures showed marked increase when the recirculation rate surpassed 40%. It was demonstrated that the changes of left heart pressures can be the key sign to know the limitation of LVAD support against AI progression, and to consider the surgical intervention. Anatomical factors could be also one of factors causing AI. It was reported that the group of patients who have obtuse angle between outflow graft and the aorta (O-A angle) can progress AI earlier. We established LVAD-AI model with seven calves, and evaluated the influence of the O-A angle. It was suggested that the obtuse O-A angle could cause increase of recirculation without pressure changes. We performed those animal experiments to give some feedback for some clinical problems. The bidirectional approach from clinical and basic research is important.