Key result
Continuous-flow left ventricular assist devices have achieved a 91% 2-year survival rate after primary implantation in Japan over the past decade.
Why the study?
An increasing heart failure population and unique opportunities to investigate acute and chronic mechanical circulatory support in Japan prompted a review of clinical outcomes and key management challenges.
Japan demonstrates high 2-year survival (91%) for continuous flow LVADs, highlighting the importance of managing long-term complications due to prolonged support times from donor shortages.
Supports favorable CF-LVAD outcomes in Japan; leaves open generalizability and need for prospective validation.
Globalization in Asia and consequent strengthening of healthcare economic factors in tandem with an increasing heart failure (HF) population have enhanced potential for development and progress in the fields of HF medicine and mechanical circulatory support (MCS). In Japan, there are unique opportunities to investigate the outcome of acute and chronic MCS and a national registry for percutaneous and implantable left ventricular assist device (LVAD) including Impella pumps has been established. A Peripheral extracorporeal membrane oxygenation (ECMO) for acute MCS has been used in more than 7000 patients annually and Impella usage in more than 4000 patients over the past 4 years was noted. Recently, a novel centrifugal pump with hydrodynamically levitated impeller was developed and approved for mid-term extracorporeal circulatory support. In terms of chronic MCS more than 1200 continuous flow LVADs have been implanted during the past decade, and 2-year survival rate after primary LVAD implantation is 91%. Because of donor organ shortage, more than 70% of heart transplant recipients required LVAD support for more than 3 years and prevention and treatment of complications during long-term LVAD support have become important. Five important topics including hemocompatibility-related complications, LVAD infections, aortic valve insufficiency, right ventricular failure and cardiac recovery during LVAD support are discussed in this review for improving clinical outcomes. Findings from Japan will continue to provide useful information regarding MCS for the Asia-Pacific region and beyond.
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Toda et al. (2023) conducted a review in Heart failure. Mechanical circulatory support was evaluated. Continuous-flow left ventricular assist devices have achieved a 91% 2-year survival rate after primary implantation in Japan over the past decade.
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