ARTIFICIAL H E A R T 2 Proceedings of the 2nd International Symposium on Artificial Heart and Assist Device, August 13-14, 1987, Tokyo, Japan Editor: Tetsuzo Akutsu Associate Editors: Hitoshi Koyanagi, Setsuo Takatani, Kazunori Kataoka, Jack G. Copeland, Stuart L. Cooper, Peer M. Portner, David B. Geselowitz Springer Japan KK TETSUZO AKUTSU, M.D., Ph.D. Vice-Director National Cardiovascular Center Research Institute 5-7-1 Fujishiro-dai Suita, Osaka 565 Japan ISBN 978-4-431-70544-4 ISBN 978-4-431-65964-8 (eBook) DOI 10.1007/978-4-431-65964-8 This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in other ways, and storage in data banks. ©Springer Japan 1988 Originally published by Springer-Verlag Tokyo Berlin Heidelberg New York London Paris in 1988 Softcover reprint of the hardcover 1st edition 1988 The use of registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and there fore free for general use. Product liability: The publisher can give no guarantee for information about drug dosage and application thereof contained in this book. In every individual case the respective user must check its accuracy by consulting other pharmaceutical literature. Publication of this proceedings was supported by the promotion fund of the Japan Keirin Association. I Typesetting: Asco Trade Typesetting Ltd., Hong Kong 2nd International Symposium on Artificial Heart & Assist Device August 13-14, 1987, Keidanren Kaikan, Tokyo, Japan Organized by Japan Research Promotion Society for Cardiovascular Diseases Sponsored by Ministry of Health and Welfare of Japan Nihon Keizai Shimbun Inc. Japanese Society for Artificial Organs Japan Keirin Association Organizing Committee President: Hiroto Yoshioka (Japan Research Promotion Society for Cardiovascular Diseases) Vice-President: Tetsuzo Akutsu (National Cardiovascular Center Research Institute) Secretary General: Hitoshi Koyanagi (The Heart Institute of Japan, Tokyo Wemen's Medical College) Members Tetsuzo Akutsu (National Cardiovascular Center Research Institute) Kenichi Asano (The Central Hospital Japanese National Railways) Kazuhiko Atsumi (Institute for Medical Electronics, The University of Tokyo) Koshichiro Hirosawa (The Heart Institute of Japan, Tokyo Wemen's Medical College) Tadashi Inoue (Department of Surgery, Keio University) Hitoshi Koyanagi (The Heart Institute of Japan, Tokyo Wemen's Medical College) Hisao Manabe (National Cardiovascular Center) Motoomi Nakamura (Research Institute of Angiocardiology, Kyushu University) Yoshio Obunai (The Sakakibara Heart Institute) Yasuhisa Sakurai (Institute of Biomedical Engineering, Tokyo Wemen's Medical College) Atsuyoshi Takao (The Heart Institute of Japan, Tokyo Wemen's Medical College) Kiichi Tsuchiya (School of Science and Engineering, Waseda University) Presidential Address President Hirota Yoshioka It is a great privilege for me to declare the 2nd International Symposium on Artificial Heart and Assist Devices open. As the president of the congress is at present incapacitated, in his stead I would like to deliver the opening address. On behalf of the organizing committee and the Japan Research Promotion Society for Car diovascular Diseases, I have the honor to extend a cordial welcome to each of the participants. First of all, I would like to thank them for their interest and efforts in helping to make this symposium possible; especial thanks go to the guests who have traveled here from the USA. I would like to express my thanks to the Ministry of Health and Welfare of Japan, Nihon Keizai Shimbun (a newspaper company), and the Japanese Society for Artificial Organs for their kind assistance. Further, for financial support, we are greatly indebted to the Japan Keirin Associa tion. The Japan Research Promotion Society for Cardiovascular Diseases organized the Research Committee for the Development of Cardiac Assist Devices in 1982 and began equipping research facilities for the artificial heart in 1983. To promote progress in this field, we planned the 1st International Symposium on Artificial Heart and Assist Devices, which was held in August 1985. To this meeting, seven distinguished speakers from the USA and Europe were invited, who covered the areas of ventricular assist devices, total artificial hearts, and biomedical materials. About 200 participants from Japan contributed greatly to the academic sessions, which proved to be most informative and fruitful. The papers and discussions presented were reviewed repeatedly by the editorial board, and finally the proceedings of the first symposium, Artificial Heart 1, was published by Springer-Verlag Tokyo. This book achieved a worldwide distribution of 1000 copies and met with a positive critical reception. I am certain that this second symposium will contribute greatly to the development of research in this field. I hope that the newest advances in this exciting and fast-moving area will lead to a third symposium with the assistance of the supporting organizations. Hitoshi Koyanagi Secretary General Greeting On behalf of the Ministry of Health and Welfare, it is a great honor to have been given this opportunity to say a few words at the opening of the 2nd International Symposium on Artificial Heart and Assist Devices. As is widely known, the primary cause of death in Japan at present is cancer. In 1985, heart disease replaced cerebral apoplexy in the number two position. With the gradual aging of the population, I think that the importance of measures against cardiac diseases will become in creasingly obvious. Positive action has been taken in terms of primary care against heart disease including arterio sclerosis, and the results of this can now be seen. Following enormous efforts by doctors, the medical treatment of severe heart disease has improved remarkably. In Europe and the USA, in addition to transplantation, the clinical application of the artificial heart is showing rapid progress. 1 a pan has developed excellent techniques in the field of electronic devices and precision machines. We believe that the application and contribution of such techniques to the medical field, in other words, interdisciplinary research and development of an artificial heart can fulfil a very important role in the management of cardiovascular diseases, and thus we would like to give a positive support to all efforts made here. It was against this background that the first international symposium was held 2 years ago, and its proceedings were published as Artificial Heart 1. This volume made a substantial contribution to worldwide research into the artificial heart. We are confident that with the present symposium research into the artificial heart will continue to make great strides and do much to increase health and welfare. Kohji Takenaka Director General of the Health Policy Bureau, the Ministry of Health and Welfare Preface It is with great pleasure that we present here Artificial Heart 2 (Proceedings of the 2nd Inter national Symposium on Artificial Heart and Assist Devices). The symposium was held in Tokyo on 13-14 August 1987 under the auspices of the Japan Research Promotion Society for Cardio vascular Diseases. In the first symposium, also held in Tokyo, in 1985, seven distinguished investigators were invited from the USA and Europe. The symposium was divided into seven sessions according to the guest speakers' speciality. Following their presentations two designated researchers in Japan discussed the pertinent subject. This time, however, papers on the Japanese side were called for and selected by the program committee. The subjects of the seven guest speakers, who were all from the USA, were as follows: 1) the second generation of ventricular assist devices (VA D) and total artificial hearts (TA H) under development, 2) clinical uses of VAD and TAH which include their applications as a bridge to heart transplantation and 3) biomaterials. When considering the patients' quality of life with an implanted artificial heart, development of a totally implantable system including the energy source is essential. From the practical stand point for clinical use, one way to solve the problems of heart replacement will be the cooperative use of artificial hearts and heart transplants. The concept of two-stage heart replacement intro duced by Dr. D.A. Cooley in 1969 has now been widely accepted, and more than 100 clinical cases have been reported to date. Due to the shortage of donor hearts a strong demand for an artificial heart which can be used for years as a permanent system with guaranties in terms of safety and reliability has been increasing. To realise such a system, development of better mate rials is of prime importance. The total number of VAD in clinical use in Japan is now over 100, and the results have been improving. To our regret, however, two-stage heart replacement is presently impossible in Japan since heart transplantation still may not be performed. In this respect we hope that a report by one group describing this topic as well as all the other exciting papers will be a good stimulant to us and will help us make further progress in this field in Japan. Tetsuzo Akutsu Contributors 1. S.L. Cooper 2. K. Hayashi 3. A. Takahara 4. N. Yui 5. Y. Ito 6.S.W. Kim 7. H. Miyama 8. T. Matsuda 9. Y. Noishiki 10. P.M. Portner 11. T. Nakamura 12. T. Akamatsu 13. D.M. Lederman 14. S. Nitta 15. H. Irie 16. M. Umezu 17. I. Yada 18. H. Adachi Contributors XI 19. Y. Kagawa 20. M. Shiono 21. M. Okada 22. H. Noda 23. J.G. Copeland 24. H. Takano 25. E. Imamura 26. J.C. Moise 27. Y. Abe 28. Y. Mitamura 29. H. Yamada 30. D.B. Geselowitz 31. T. Chinzei 32. K. Maeda 33. K. Nishimura 34. Y. Taenaka 35. K. Imachi 36. H. Fukumasu 37. S. Fukunaga 31\. S. Takatani