Fifteen-year experience with Toyobo paracorporeal left ventricular assist system

Our 15-year experience of the Toyobo paracorporeal left ventricular assist system (LVAS) at Osaka University Hospital was reviewed. In total, 61 patients underwent Toyobo LVAS implantation from January 1992 to August 2007. Their mean age was 38.1 ± 16.9 years. The etiologies of heart failure were idiopathic dilated cardiomyopathy in 35 patients, ischemic cardiomyopathy in 15, myocarditis in 5, secondary cardiomyopathy in 4, and others in 2. Preoperatively, intubation was required in 41 patients (67.3%), an intra-aortic balloon pump was required in 38 (62.3%), and extracorporeal membrane oxygenation was required in 30 (49.2%). Four patients underwent heart transplantation and 11 underwent LVAS removal. Of those 11 patients, 4 were subjected to emergent removal because of device complications and all of them died. Of the 7 patients that underwent scheduled LVAS removal, heart failure recurred in 2 patients and reimplantation was required. In terms of major device-related complications, cerebral hemorrhage occurred in 16 patients (26.2%), cerebral infarction in 19 (31.1%), mediastinitis in 10 (16.4%), and inflow/outflow cannula exit site infection in 19 patients (31.1%). The actuarial survival rate of the patients operated on in the last 5 years of this study was 66.3% at 6 months and 45.9% at 1 year. Although the survival rate of patients supported by the Toyobo LVAS has recently improved, the morbidity rate is significant. Considering the current severe shortage of heart donors in Japan, it is important to introduce more durable devices with fewer complications and to establish the strategies for using the LVAS as a bridge to recovery.