琉球大学病院における植込み型補助人工心臓治療の現状と展望

The use of implantable ventricular assist device（iVAD）has dramatically increased since 2011 in Japan as a bridge to heart transplantation for advanced heart failure with low operative mortality. We report the current status and prospects of iVAD therapy at the University of the Ryukyus Hospital. At our institution, 19 iVAD implantations have been performed so far. The average age was 48（34-64）years and two were females. During a mean follow-up of 45（5-70）months, there was one perioperative death（Operative mortality: 5%）and four late deaths. Cumulative survival rates were 92.9% at 1 year and 86.9% at 3 years. We introduced three main infection control methods that we have used and reported their effectiveness. Patients who live in Okinawa, must temporarily move to the vicinity of the Tokyo University Hospital when they undergo heart transplantation. Once they are registered for transplantation, they will move to Tokyo and live in the vicinity of the Tokyo University Hospital for about 1 year until their condition stabilizes. The cost of living in Tokyo is a burden for them. The "Basho-no-kai" was launched in 2019 to raise funds and collect signatures to improve the health care system in Okinawa Prefecture to reduce this economic disparity. We plan to continue to support their living expenses as well as subsidize the cost of developing transplantation treatment. In Japan, insurance will cover iVADs as a destination therapy from 2021 at a limited number of facilities. Facility accreditation is our goal to provide this treatment because it improves the quality of life compared to medical treatment. Right heart failure is a serious complication after iVAD therapy. To manage this complication, we have developed a simple valved anastomosis at the superior vena cava and the right pulmonary artery, which allows blood flow into the pulmonary artery from the superior vena cava using the increased venous pressure. If this study can be applied clinically, it may contribute to the right heart failure resolution in long-term iVAD patients in the future. Approach to regenerative medicine, HeartSheet® is a product where skeletal myoblasts contained in muscle tissue collected from the patient's thigh are cultured and prepared in sheet form, which is then transplanted into the patient's heart surface for severe heart failure caused by ischemic heart disease. We will prepare to participate in this research. Ryukyu Med. J., 41 (1～4) 1～8, 202

Transapical aortic perfusion using a deep hypothermic procedure to prevent dissecting lung injury during re-do thoracoabdominal aortic aneurysm surgery

Abstract Background Avoiding various complications is a challenge during re-do thoracoabdominal aneurysm surgery. Case presentation A 56-year-old man had undergone surgery for type I aortic dissection four times. The residual thoracoabdominal aortic aneurysm that had severe adhesions to lung parenchyma was resected. Since the proximal anastomotic site was buried in lung parenchyma, deep hypothermia was essential to avoid lung dissection and to protect the spinal cord during the proximal anastomosis. The deep hypothermia was induced with bilateral infusion of cardiopulmonary bypass by femoral artery cannulation for the lower body and by transapical cannulation for the upper body because of easy access. There was no hemorrhagic tendency after deep hypothermic bypass. The patient was discharged uneventfully. Conclusions For upper body perfusion, transapical aortic cannulation was a simple and effective procedure during left thoracotomy