Osaka University Hospital

drive line, the first time this has been done in Japan. This can lead to reduced infection rates and also allows the patient to swim and take a bath, an important part of Japanese life. A novel treatment that I observed at Osaka University Hospital was myocardial sheet transplantation. Skeletal myocytes are removed from a patient, stimulated to develop

Medical students from Osaka University Medical School, into cardiomyocytes and are

University of Malaysia Sarawak and Myself (2nd left), with finally implanted onto the

Prof Yoshiki Sawa - Osaka University Medical School Dean patients epicardium. The desired effect being improved

Osaka University Hospital is a left ventricular ejection fraction, and large tertiary centre located in the improved cardiac remodelling. Osaka Suita district of Osaka. It has 50 University Hospital is one of the main inpatient beds, as well as a large ITU. It is a centres of research in this field, and it was world leader in implantable ventricular assist interesting learning about it and the exciting devices (VAD) and regenerative medicine. applications it may have in the future. Patients are accepted from throughout Japan Finally, as mentioned earlier, Osaka from Hokkaido in the North to Okinawa in University Hospital is one of the 11 in Japan the far South West, as well as from abroad. It that are licensed to carry out adult heart is also one of the 11 centres in Japan with a transplantation. Heart transplantation only license to carry out heart transplant surgery. began in 2005, with numbers exceptionally

The most prevalent cardiovascular low until a change in the law in 2014. diseases in Japan are the same as those in the Numbers of transplants have remained low, UK. Including Ischaemic heart disease, atrial despite a population of 120 million. In Japan fibrillation, hypertension, cerebrovascular only 51 heart transplants were carried out in disease, peripheral artery disease and heart 2016, this compares with 195 in the UK, a failure. Notably the incidence of aortic dissection country with a population of approximately is higher in Asian populations, with rates being half that and 68 per day in the United States. 3 times greater than those seen in Europe. The issues with low transplant numbers Whilst on my placement in Osaka I was are common to both health systems and able to observe a wide range of adult are largely due to low number of donors. cardiac surgery inncluding off pump CABG, Donor rates are lower in Japan than in the combined AVR/MVR, and aortic arch UK, perhaps for cultural reasons and also a replacement following dissection. patient`s family can block organ donation even

One difference between Osaka and if the patient was previously registered as an my previous placements at Barts is the organ donor, like in the United Kingdom. provision of Ventricular Assist Devices, a Importantly my time in Japan was not procedure not currently carried out at Barts all spent in the hospital. I was able to explore Heart Centre. Whilst I was there I saw the the magnificent sites such as Todaiji temple implantation of a VAD with a postauricular in Nara, Himeji castle, the shrines of Kyoto, take in a rugby game in Tokyo, as well as the humbling peace park and ground zero at Hiroshima. Whilst initimidating and a bit overwhelming at first Japan is an incredible country, with distinct differences in their culture and attitudes as well as the healthcare system. I have thoroughly enjoyed my time in Japan and cannot wait to visit again in the future and I would encourage anyone else to do the same.

I would like to thank Mr and Dr Ionescu and the SCTS for their generous support, without which I would not have been able to complete this elective. n