Bridge-to-Bridge Left Ventricular Assist Device Implantation Strategy vs. Primary Left Ventricular Assist Device Implantation Strategy

Abstract

those with INTERMACS profile 1, 4 the paracorporeal pulsatile LVAD implantation (Nipro VAD or AB5000), a counterpart of the Thoratec PVAD (Thoratec, Pleasanton, CA, USA), has long been used as a strategy for bridge-todecision or -candidacy, followed by conversion to durable LVAD as a bridge-to-transplantation (i.e., secondary device) if applicable. Recently, an extracorporeal continuousflow centrifugal pump (RotaFlow, Gyro pump, or Mera pump), which is a counterpart of CentriMag (Levitronix LLC, Waltham, MA, USA), has replaced almost all paracorporeal pulsatile LVADs, because of having fewer adverse events. In addition, central extracorporeal membranous G iven the improvement of mechanical assist device technology and increasingly sophisticated perioperative management, the mortality and morbidity following durable left ventricular assist device (LVAD) implantation have greatly improved, particularly among those with stable preoperative hemodynamics dependent on continuous inotropes who typically are classified as INTERMACS profile 3. 1,2 However, optimal therapeutic strategies for those with clinical deterioration assigned to INTERMACS profile 1 remain controversial. 3 Based on the guidelines from Japanese academic societies, which do not recommend durable LVAD implantation for

Impact of Different Therapeutic Strategies With Left Ventricular Assist Devices on Health-Related Quality of Life During Prolonged Device-Based Support

“…Furthermore, the VAS scores at 3 and 12 months after VAD implantation improved by a greater extent in the G-BTB than G-pLVAD and G-iLVAD groups. Therefore, although the survival rate is slightly lower for BTB than for iLVADs, 7 , 24 BTB was significantly better than pLVAD alone in terms of patient survival and HRQoL in the present study.…”

Consensus Report on Destination Therapy in Japan ― From the DT Committee of the Council for Clinical Use of Ventricular Assist Device Related Academic Societies ―

“…The data from J-MACS registry show that age and the BTB strategy are independent poor prognostic factors. 11 Therefore, BTB may be difficult for older adults, and indication should be considered carefully with J-HMRS <1.58 at the time of conversion.…”

JCS/JSCVS/JCC/CVIT 2023 Guideline Focused Update on Indication and Operation of PCPS/ECMO/IMPELLA

“…30 Because the outcomes of BTB are not favorable in terms of survival and cerebrovascular event rates compared with primary LVAD implantation, careful consideration is necessary when evaluating its indications. 143,144 In contrast, it is important to consider upgrading the MCS, including extracorporeal VADs, without hesitation when multiple organ damage due to unstable hemodynamics is progressing, despite temporary MCS.…”