本邦における植込み型補助人工心臓治療の現在地

Current Status of Implantable Ventricular Assist Device

本邦では，心臓移植適応患者に対する心臓移植までの橋渡し治療（bridge to transplant：BTT）としての植込み型補助人工心臓（implantable ventricular assist device：iVAD）治療が2011年にはじめて保険収載された．以降，「日本における補助人工心臓に関連した市販後のデータ収集（Japanese registry for Mechanically Assisted Circulatory Support：J-MACS）」からの報告によると，2023年12月31日までに1,458例のiVAD手術がBTTとして施行され，年間植込み数もここ10年間で飛躍的に増加している1）．

Implantable ventricular assist device （iVAD） was initially approved in Japan as bridge-to-transplantation （BTT） indication in 2011. Since then, 1,458 iVAD implants were performed as BTT, and this number per year is rapidly increasing, especially after the approval of iVAD implant as destination therapy （DT） indication in 2021. Some of DT patients will be eventually registered for heart transplantation, once their exclusion criteria are cleared, thus extending waiting time of BTT patients in the setting of serious donor shortage in Japan. Therefore, to improve the outcome of iVAD patients, both BTT and DT, it is imperative to manage device-associated complications that can occur during prolonged long-term iVAD support. In the present review, we summarize the recent updates on the iVAD treatment in Japan, in terms of device-associated complications, especially driveline infection, right ventricular failure and aortic regurgitation.