講演情報
[II-AHAJS-4]Long term mechanical circulatory support in children waiting for Heart transplantation in Japan
○Mikiko Ishido1, Takeshi Shinkawa2 (1.Department of Pediatric and Adult congenital Cardiology, Tokyo Women's Medical University, Tokyo, Japan, 2.Department of Thoracic Cardiovascular Surgery, Tokyo Women's Medical University, Tokyo, Japan)
キーワード：
Ventricular assist device、Heart transplantation、wait list
In Japan, ＞95% of children underwent orthotopic heart transplantation (HTx) were supported by ventricular assist device(VAD). This is mainly because long waiting time, as long as 675 days in children. There're only 16 pediatric HTxs in 2023 where there're 50 new patients (Pt) considered to require HTx every year. Since 2015, Berlin Heart EXCOR was introduced in Japan, and it allows Pt to wait long period, as long as 4 years in our institute. The 10ml pump has been utilized mostly which's unusual for other countries. Nevertheless, we could keep serious complication rate and mortality low, probably due to precise anticoagulation and meticulous wound disinfection. But physical restraint and long hospital stay result in developmental delay and motor dysfunction in some cases. Also, one of the family members needs to stay with Pt in the hospital for 24/7 in most cases, which can influence on the family especially siblings. Therefore, we've been trying to use implantable VAD (iVAD) for children ＞20kg. The youngest Pt supported by Heartmate-III is 6 years old in our experience. iVAD allows Pt to go home and back to school. We give VAD training to not only Pts’ family, but school teaches. Pt or the family take care of the exit site of the drive line every day, coagulation check 1-2 times a week, mechanical checkup with clinical engineer and outpatient clinic with cardiologist or surgeon 1-2 times a month are the routine for iVAD Pt. Minor stroke, subarachnoid bleeding, and drive line infection are the major complications in our cases without delisting or mortality so far.