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Use of Two Intracorporeal Ventricular Assist Devices As a Total Artificial Heart
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The Present Situation and Clinical Topics of Ventricular Assist Device and Heart Transplantation in Japan

Yoshihisa Tanoue, Akira Shiose

    Fukuoka Igaku Zasshi = Hukuoka Acta Medica
    |December 12, 2017
    PubMed

    Insights

    Surgical options for heart failure are expanding, including ventricular assist devices (VADs). Current VAD use is limited, but destination therapy trials aim to broaden access for severe heart failure patients.

    Area of Science:

    • Cardiovascular Surgery
    • Regenerative Medicine
    • Medical Technology

    Background:

    • Surgical treatments for heart failure encompass bypass grafting, valve repair, ventricular restoration, VADs, and transplantation.
    • Regenerative medicine, such as HeartSheet, offers novel therapeutic approaches.
    • Implantable ventricular assist devices (LVADs) have improved survival for severe heart failure patients since 2011.

    Purpose of the Study:

    • To review current surgical treatments for heart failure.
    • To highlight the limitations in current indications for implantable LVADs.
    • To discuss the potential of destination therapy (DT) for expanding LVAD use.

    Main Methods:

    • Literature review of surgical interventions for heart failure.
    • Analysis of current guidelines and insurance reimbursement for VADs in Japan.
    • Discussion of ongoing clinical trials for destination therapy.

    Main Results:

    • LVADs significantly improve life prognosis but are primarily indicated as a bridge to transplantation.
    • Age restrictions for heart transplantation in Japan limit LVAD eligibility under health insurance.
    • Destination therapy trials are underway to optimize LVAD indications.

    Conclusions:

    • Current LVAD indications are restrictive, mirroring heart transplantation criteria.
    • Expanding VAD therapy, including destination therapy, requires broader social acceptance.
    • Further research and clinical trials are crucial for optimizing VAD treatment strategies.

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