Current Status of Treatment for Advanced Heart Failure of Children in the United States

Abstract

In the United States, approximately 400 pediatric heart transplants are performed each year. When a deceased organ donor is identified, the UNOS’ computer system generates a ranked list of transplant candidates based on blood type, medical urgency, waiting time, expected benefit, geography, and other medical criteria. The average waiting time is approximately 2–3 months. The survival rate after the transplant is improving and the 5-year survival rate after the transplant is approximately 80％. Dilated cardiomyopathy is the most common indication for the transplant, but approximately 40％ of the cases are with congenital heart disease, and transplantation after Fontan failure has been increasing recently. The most common circumstance of brain death is a motor vehicle accident, but unlike Japan, child abuse is also included. After the approval of the Berlin heart EXCOR in 2011, the number of patients with VAD is increasing and the results are excellent. There are some promising pediatric implantable VADs in the market and in preclinical trials.