[Indication and clinical results of heart transplantation in the terminal stage of ischemic cardiomyopathy].

The results of medical therapy has been very poor for ischemic cardiomyopathy with inoperable coronary artery disease and left ventricular ejection fraction less than 20%, therefore, heart transplantation is considered to be definite indication for those patients. However, the limited supply of suitable donor organs imposes constraints upon the decision of whether patients are selected for transplantation or for alternative therapy including coronary artery bypass grafting (CABG), semipermanent use of implantable left ventricular assist device, or cardiomyoplasty even in the western countries. The heart transplantation therapy has not been accepted in Japan at the present time, therefore, such alternative therapy should be tried still more aggressively in our country. CABG is most established surgical technology among the alternative therapies for transplantation and realistic in availability. Many institutes in the western countries adopt the therapeutic strategy of aggressive trial of CABG for ischemic cardiomyopathy in the first stage and to use ventricular assist device as a bridge for heart transplantation in failure cases. Although the effects of CABG may not be permanent and ultimate heart transplantation may be required for those patients, still CABG therapy is considered reasonable, because of the shortage of supply of donor heart, rejection and the progression of coronary artery disease of transplanted heart in the chronic stage. The necessity and indication of heart transplantation for ischemic cardiomyopathy have not been discussed adequately in Japan, however, more than 5000 patients under 60-year-old are killed annually due to ischemic heart disease in our country. More hot discussion on heart transplantation is deems to be necessary for ischemic cardiomyopathy.