大転換期を迎えた植込み型補助人工心臓治療

Era of Major Transformation in Implantable Ventricular Assist Device Therapy

われわれの施設は岩手県盛岡市に位置し，県内唯一の植込み型補助人工心臓（iVAD）実施施設である．岩手県は人口減少の顕著な県の一つであるが，心臓外科黎明期からの県医療局の一貫した方針により，心臓血管外科施設は岩手医科大学附属病院と当院の2施設に集約化されており，高額の設備投資を必要とする心臓血管外科医療を効率よく安定的に提供していくうえで理想的な環境が構築されている．人口減少地域にあって当院が認定を維持できているのは，この施設集約も大きな要因の一つと認識している．

Our hospital received certification as an implantable ventricular assist devices （iVAD） facility in 2018, and as of 2024, we continue to maintain this certification. We provide outpatient and inpatient care through a multidisciplinary heart team. Our team has implanted HeartMate 3 in three patients, and we also manage five patients with devices implanted at other facilities, for a total of eight iVAD patients under outpatient care. Fortunately, we have had no cases of readmissions due to driveline infections or cerebrovascular events. We recognize that, in addition to advancements in surgical techniques and device technology, close collaboration between patients and the heart team, as well as the involvement of wound, ostomy, and continence （WOC） nurses, are essential. Recently, this field has entered a major transformation. With improvements in heart failure treatment by the ʻfantastic fourʼ and the advancements in Impella technology, the need for extracorporeal ventricular assist device （EVAD） has significantly declined, and cases achieving a bridge to recovery are not uncommon. Furthermore, as the number of stable iVAD patients grows, not only are destination therapy （DT） cases increasing, but elderly patients are effectively becoming DT cases, underscoring the importance of iVAD facilities in providing end-of-life case for these patients.