[End-stage heart failure]

The ultimate treatment for end-stage heart failure patients is cardiac transplantation. However, many Japanese candidates have not received its benefits due to the extreme scarcity of donor hearts. The heart transplant waiting period in Japan is prolonged, particularly after the revision of the Organ Transplantation Law in 2010 which meant that patients must wait more than 900 days because of the increase in candidates. According to the Japanese Transplant Registry, almost 90% of candidates require bridge transplantation therapy (BTT) with a ventricular assist device (VAD), and the average duration of BTT is around 800 to 900 days. The excellent outcome of heart transplant surgery in Japan even with such a prolonged BTT duration with VADs is confirmation of the excellent clinical results of VAD support. Until April 2011, only the paracorporeal Nipro VAD for BTT was covered by Japanese national health insurance. Analysis of the clinical outcome of 303 patients who received a Nipro VAD (for left ventricular [LV] drainage) as BTT showed that the longest support duration was 1,673 days (average 427 days), 72 patients (24%) received a heart transplant, and 68 patients (22%) required ongoing VAD support. Thus the Nipro VAD is an excellent paracorporeal device. The 6-year survival rate of 36 patients in clinical trials of four types of implantable rotary blood pump LVADs (Evaheart, DuraHeart, Jarvik 200, HeartMate II) was about 70%, which is an outstanding result of BTT using implantable LVADs. Only 36 patients in seven Japanese heart centers have received implantable LVADs, and this small number corresponds to the initial learning curve. Therefore, the clinical results will improve greatly after the use of commercially available implantable LVADs becomes more widespread. The long waiting period for heart transplantation has contributed to the excellent clinical outcomes of VAD therapy in Japan.