Abstract
Development of the ventricular assist device (VAD) started in the 1960s, and bridge use of VAD in heart transplantations (BTTs) started in the 1980s. Thereafter VAD spread widely in Western countries. The commercially available first generation of pulsatile-flow implantable left ventricular assist device became popular as a BTT device in the 1990s, and the second and third generations of continuous-flow implantable LVADs were introduced in the 2000s. The concept of destination therapy (DT) with implantable LVAD was proposed by a Columbia University team in 1997. According to the results of the REMATCH study and the HeartMate II DT study in the United States, DT indication of HeartMate VE was reimbursed in 2002 for patients ineligible to receive heart transplantations, and that of HeartMate II in 2010. A shortage of donor hearts is now serious even in the United States, where heart transplants have become popular as a standard treatment of severe heart failure. Therefore DT cases are rapidly increasing. The shortage of donor hearts in Japan is extreme, and the annual number of donor hearts to be the thirtieth of the US population ratio, heart transplants never gained the status of standard therapeutic strategy for severe heart failure in Japan. At the moment, implantable LVAD is reimbursed only for BTT indication. If we view the primary role of an implantable LVAD as an alternative treatment for a heart transplant, we should begin to discuss how to introduce DT into Japanese clinical fields as soon as possible.