Development of ventricular assist device and heart transplantation in Japan: How people worked
Bibliographic record
Abstract
The first heart transplantation (HTx) in Japan was carried out in Sapporo by Dr. J. Wada 8 months after Dr. C. Barnard performed the world's first case in Cape Town, South Africa in 1967. 1 After the recipient's death, doubts spread through mass media about the brain death and indication to that patient with valvular disease, which led to demand that the surgeon be tried for murder. 2 After this problematic case, organ transplantation from brain-dead donors was not carried out for the next three decades.After long arguments about organ transplantation from brain-dead donors, and after suffering from another antitransplant action, 3 the law allowing donation of the organs under brain death passed the Diet in 1997.HTx under legislation was started smoothly in 1999.However, over the next 10 years, organ donation was very limited because of the stringent law as donations were only possible under the presence of written will of the donor and acceptance from the family.In 2010, the law was revised as accepting the donation without donor's written will and the number of HTx has increased significantly.The cumulative number of HTx has reached over 500 in 2019.However, HTx itself has been still limited not exceeding over 100 cases per year.The development of devices for mechanical circulatory support (MCS) started very early in Japan, and two groups, one at the University of Tokyo (UT) and one at the National Cardiovascular Center (NCVC), began to develop extracorporeal ventricular assist devices (VADs) in the 1970s.The UT released the Zeon pump and the NCVC released the Toyobo pump in the 1980s.Considering the long waiting period for the coming HTx era, efforts to introduce implantable VADs (left ventricular assist devices, LVADs) were conducted starting with pulsatile devices, HeartMate (HM), and Novacor, and then, moved toward the continuous flow LVADs.During the above period, Japanese original LVADs, the EVAHEART and the DuraHeart were developed.Currently, the national supportive scheme for introducing durable LVADs has progressed under the academic autonomy system, and a significant increase of the newly implanted durable VADs has been over 100 in recent years.However, the indication of such VADs has been limited to bridge use for HTx and destination therapy (DT) has not been started.In this article, the historical steps of clinical application of advanced therapeutic modalities such as VAD and HTx are reviewed to show how the people involved struggled and worked together.This review has intended to cover the period from 1980s to mid-2010s when I worked mainly at Osaka University (Professorship was from 1991 to 2005).
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.005 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.006 | 0.006 |
| Scholarly communication | 0.006 | 0.007 |
| Open science | 0.001 | 0.005 |
| Research integrity | 0.004 | 0.005 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".