植込み型左室補助人工心臓患者の再入院予防と綿密な長期外来管理とシェアードケア

Long-term Outpatient Management and Shared Care Practices to Prevent Rehospitalization and Improve Quality of Life in Patients with 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（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2021年12月までに本邦で約1,300例のiVAD手術がBTTとして施行された1）．さらには，2021年4月に永久植込み使用（destination therapy：DT）として保険収載され，さらなる手術数の増加が見込まれている．

According to a statistical report from the Japanese registry for Mechanically Assisted Circulatory Support, the readmission rate is 85％ at three years, mainly due to driveline infection. The prevention of adverse events such as driveline infections is important to improve the quality of life of patients, an issue that needs to be emphasized more in these days when longer waiting periods for transplantation and destination therapy are becoming more common. In addition to monthly outpatient visits, we provide weekly e-mail consultations and promote collaboration with shared care facilities. Our driveline infection rate was 20％ at three years, and the readmission rate was an excellent 27％ at three years. The results suggest that our long-term outpatient management may have contributed to the improvement of quality of life by reducing adverse events such as driveline infections and preventing rehospitalization.