[ISPHLT-SY1-3] Pediatric heart transplantation in NCVC
With the revision of the Organ Transplant Law, the extension of insurance cover to implantable ventricular assist devices and Berlin Heart EXCOR, major changes have been brought to heart transplantation in Japan in the past decade. The insurance coverage to Berlin Heart EXCOR, in particular, has had a major impact on the current state of pediatric heart transplantation in Japan, which requires a long waiting period for a bridge-to-transplant assist device. The number of patients wishing to travel overseas for transplantation has decreased, and the number of patients on the waiting list for heart transplantation in Japan has increased, making us realize that we are approaching a future where Japanese people can be saved by Japanese people. On the other hand, there are still problems that need to be improved. These include chronic heart failure in the patients with congenital heart disease (CHD) long after the surgery and the protein losing enteropathy after Fontan operation. In the CHD patients long after the surgery, restrictive heart failure is common, and how to avoid to increase central venous pressure and multiple organ (especially liver and kidney) damage during the long waiting period for transplant. In the failed Fontan patients, pulmonary circulatory failure, not ventricular dysfunction, is overwhelmingly associated with heart failure. In Failed Fontan cases, not ventricular dysfunction, but pulmonary circulatory failure is overwhelmingly involved in heart failure. Therefore, left ventricular support alone will not improve the condition, and some new approach to improve hemodynamics or modification of waiting status classification will be necessary. It is not so difficult to discuss such medical indications because of the precedents set in Western countries, but we have to discuss the unique problems faced by adults with congenital heart disease (ACHD). There are many ACHD who are separated from society by long hospital visit, hospitalization, and economic problems. I feel that it is also an important issue to further improve the determination of social indication for heart transplantation in such ACHD patients.