Journal of Artificial Organs

, Volume 17, Issue 3, pp 220–227 | Cite as

Operative modification for the prevention of device-related infection during NIPRO extracorporeal left ventricular assist device implantation

Original Article Artificial Heart (Clinical)


An operative modification in which the NIPRO left ventricular assist device (LVAD) cannulas are passed through the intraperitoneal cavity is performed as the first-choice standard technique in our institution. Eighteen consecutive patients who underwent NIPRO LVAD implantation as heart transplantation candidates were enrolled in this study. The cannulas were passed through the intraperitoneal cavity in 11 patients (Group IP) and the extraperitoneal space in 7 patients (Group EP). A device-related major infection was defined as bloodstream infection and/or abscess formation in the deep tissue space. Device-related major infection occurred in 6 patients in Group IP and in 6 patients in Group EP. Of these patients, 3 patients in Group IP and 5 patients in Group EP suffered from uncontrollable bloodstream infection and finally died of development into multiple organ failure and/or cerebrovascular accidents. The actuarial rates of freedom from device-related major infection at 6 months after LVAD implantation were 100 % in Group IP and 38 % in Group EP, respectively (p = 0.02). Moreover, the actuarial survival rates after the initial device-related major infection in Group IP could be significantly higher than in Group EP (83 and 67 % at 6 months, p = 0.03). We demonstrated that this operative modification can contribute to prevention of progression of superficial skin infection to critical infection and to extension of the survival duration after the initial device-related major infection.


Left ventricular assist device Ventricular assist device Infection Extracorporeal NIPRO 


  1. 1.
    Miller LW, Pagani FD, Russell SD, John R, Boyle AJ, Aaronson KD, Conte JV, Naka Y, Mancini D, Delgado RM, MacGillivray TE, Farrar DJ, Frazier OH. HeartMate II clinical investigators. Use of a continuous-flow device in patients awaiting heart transplantation. N Engl J Med. 2007;357:885–96.PubMedCrossRefGoogle Scholar
  2. 2.
    Slaughter MS, Rogers JG, Milano CA, Russell SD, Conte JV, Feldman D, Sun B, Tatooles AJ, Delgado RM 3rd, Long JW, Wozniak TC, Ghumman W, Farrar DJ, Frazier OH. HeartMate II investigators. Advanced heart failure treated with continuous-flow left ventricular assist device. N Engl J Med. 2009;361:2241–51.PubMedCrossRefGoogle Scholar
  3. 3.
    Kitamura S. Heart transplantation in Japan: a critical appraisal for the results and future prospects. Gen Thorac Cardiovasc Surg. 2012;60:639–44.PubMedCrossRefGoogle Scholar
  4. 4.
    Yamakawa M, Kyo S, Yamakawa S, Ono M, Kinugawa K, Nishimura T. Destination therapy: the new gold standard treatment for heart failure patients with left ventricular assist devices. Gen Thorac Cardiovasc Surg. 2013;61:111–7.PubMedCrossRefGoogle Scholar
  5. 5.
    Takatani S, Matsuda H, Hanatani A, Nojiri C, Yamazaki K, Motomura T, Ohuchi K, Sakamoto T, Yamane T. Mechanical circulatory support devices (MCSD) in Japan: current status and future directions. J Artif Organs. 2005;8:13–27.PubMedCrossRefGoogle Scholar
  6. 6.
    Morita S. An old ventricular assist device still working for patients with end-stage heart failure in Japan. Circ J. 2011;75:53–4.PubMedCrossRefGoogle Scholar
  7. 7.
    Tanoue Y, Tominaga R. The present situation and clinical topics of ventricular assist device in Japan. Fukuoka Acta Medica. 2012;103:191–8 (in Japanese).Google Scholar
  8. 8.
    Saito S, Matsumiya G, Sakaguchi T, Fujita T, Kuratani T, Ichikawa H, Sawa Y. Fifteen-year experience with Toyobo paracorporeal left ventricular assist system. J Artif Organs. 2009;12:27–34.PubMedCrossRefGoogle Scholar
  9. 9.
    Sasaoka T, Kato TS, Komamura K, Takahashi A, Nakajima I, Oda N, Hanatani A, Mano A, Asakura M, Hashimura K, Niwaya K, Funatsu T, Kobayashi J, Kitamura S, Shishido T, Wada K, Miyata S, Nakatani T, Isobe M, Kitakaze M. Improved long-term performance of pulsatile extracorporeal left ventricular assist device. J Cardiol. 2010;56:220–8.PubMedCrossRefGoogle Scholar
  10. 10.
    Shiga T, Kinugawa K, Hatano M, Yao A, Nishimura T, Endo M, Kato N, Hirata Y, Kyo S, Ono M, Nagai R. Age and preoperative total bilirubin level can stratify prognosis after extracorporeal pulsatile left ventricular assist device implantation. Circ J. 2011;75:121–8.PubMedCrossRefGoogle Scholar
  11. 11.
    Maeda T, Tanoue Y, Nakashima A, Tominaga R. Atypical presentation of an apical pseudoaneurysm in a patient on prolonged left ventricular mechanical support. Interact Cardio Vasc Thorac Surg. 2010;10:350–1.CrossRefGoogle Scholar
  12. 12.
    Radovancevic B, Frazier OH, Duncan JM. Implantation technique for the HeartMate left ventricular assist device. J Card Surg. 1992;7:203–7.PubMedCrossRefGoogle Scholar
  13. 13.
    Wasler A, Springer WE, Radovancevic B, Myers TJ, Stutts LA, Frazier OH. A comparison between intraperitoneal and extraperitoneal left ventricular assist system placement. ASAIO J. 1996;42:M573–6.PubMedCrossRefGoogle Scholar
  14. 14.
    Ushijima T, Tanoue Y, Hirayama K, Nakashima A, Tominaga R. A case of conversion of a NIPRO ventricular assist system to an EVAHEART left ventricular assist system. J Artif Organs. 2013;16:248–52.PubMedCrossRefGoogle Scholar
  15. 15.
    Toda K, Yonemoto Y, Fujita T, Shimahara Y, Sato S, Nakatani T, Kobayashi J. Risk analysis of bloodstream infection during long-term left ventricular assist device support. Ann Thorac Surg. 2012;94:1387–93.PubMedCrossRefGoogle Scholar
  16. 16.
    Saito S, Matsumiya G, Sakaguchi T, Miyagawa S, Yoshikawa Y, Yamauchi T, Kuratani T, Sawa Y. Risk factor analysis of long-term support with left ventricular assist system. Circ J. 2010;74:715–22.PubMedCrossRefGoogle Scholar
  17. 17.
    Shrager JB, Wain JC, Wright CD, Donahue DM, Vlahakes GJ, Moncure AC, Grillo HC, Mathisen DJ. Omentum is highly effective in the management of complex cardiothoracic surgical problems. J Thorac Cardiovasc Surg. 2003;125:526–32.PubMedCrossRefGoogle Scholar
  18. 18.
    Shafii AE, Chamogeorgakis TP, Gonzalez-Stawinski G. Omental flap transposition with intra-abdominal relocation for LVAD pump-pocket infection. J Heart Lung Transplant. 2011;30:1421–2.PubMedCrossRefGoogle Scholar
  19. 19.
    Zhang QX, Magovern CJ, Mack CA, Budenbender KT, Ko W, Rosengart TK. Vascular endothelial growth factor is the major angiogenic factor in omentum: mechanism of the omentum-mediated angiogenesis. J Surg Res. 1997;67:147–54.PubMedCrossRefGoogle Scholar
  20. 20.
    Silverman KJ, Lund DP, Zetter BR, Lainey LL, Shahood JA, Freiman DG, Folkman J, Barger AC. Angiogenic activity of adipose tissue. Biochem Biophys Res Commun. 1988;153:347–52.PubMedCrossRefGoogle Scholar
  21. 21.
    Matsuyama S, Sonoda H, Yamaki Y, Oishi Y, Tanoue Y, Nishida T, Nakashima A, Shiokawa Y, Tominaga R. Laparotomy for acute cholecystitis after extracorporeal left ventricular assisted system implantation. Jpn J Cardiovasc Surg. 2012;41:304–7 (in Japanese).CrossRefGoogle Scholar
  22. 22.
    Suwa H, Seguchi O, Fujita T, Murata Y, Hieda M, Watanabe T, Sato T, Sunami H, Yanase M, Hata H, Nakatani T. Paracorporeal ventricular assist device as a bridge to transplant candidacy in the era of implantable continuous-flow ventricular assist device. J Artif Organs. 2014;17:16–22.PubMedCrossRefGoogle Scholar
  23. 23.
    Yoshioka D, Sakaguchi T, Saito S, Miyagawa S, Nishi H, Yoshikawa Y, Fukushima S, Ueno T, Kuratani T, Sawa Y. Initial experience of conversion of Toyobo paracorporeal left ventricular assist device to DuraHeart left ventricular assist device. Circ J. 2012;76:372–6.PubMedCrossRefGoogle Scholar
  24. 24.
    Imamura T, Kinugawa K, Shiga T, Endo M, Kato N, Inaba T, Maki H, Hatano M, Yao A, Nishimura T, Hirata Y, Kyo S, Ono M, Nagai R. Preoperative levels of bilirubin or creatinine adjusted by age can predict their reversibility after implantation of left ventricular assist device. Circ J. 2013;77:96–104.PubMedCrossRefGoogle Scholar

Copyright information

© The Japanese Society for Artificial Organs 2014

Authors and Affiliations

  1. 1.Department of Cardiovascular SurgeryKyushu UniversityFukuokaJapan

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