Heart transplantation. Dr. Anton Titov, MD. You run one of the largest departments in Europe for heart transplantation. It was published that you do more than 90 heart transplants per year. What are the most common indications today for heart transplantation? Dr. Anton Titov, MD. Maybe by age group. Sometimes we look at children. The main indication is congenital heart malformation. Medical second opinion is important. Dr. Pascal Leprince, Transplant Surgeon. We don't do any children's heart surgery here at the Salpetriere Hospital. Other hospitals in Paris, Necker Hospital, perform pediatric cardiac surgery. When we go to adults, we have two main indications for heart transplantation. We have two etiologies [causes] for heart failure. One cause of heart failure is ischemia. These are patients with coronary artery disease. They have a myocardial infraction. Then develop heart failure. I would say this is 40% of the patients who require heart transplantation. Another 40 - 45% of the patients who need heart transplantation have idiopathic dilated cardiomyopathy. "Idiopathic" means we don't know why these patients have cardiomyopathy. Many of them have familial cardiomyopathy. Some patients have multiple family members with bad cardiomyopathy. Some patients have a genetic mutation [that causes dilated cardiomyopathy]. In some, we don't know why they have dilated cardiomyopathy. These are the main causes of heart failure in adults. They represent 85 - 90% of the reasons for heart transplantation in adults. Other reasons for cardiac transplantation include amyloidosis. There are two types of amyloidosis. It starts to be very technical. I don't even understand the details of amyloidosis subtypes. There are also arrhythmic cardiomyopathy and hypertrophic cardiomyopathy that results in heart failure. This then requires heart transplantation. These are the main reasons for heart transplantation in adult patients. One thing about heart transplantation I have been repeating more many years now. Let's look at the patients who need heart transplantation because they have terminal heart failure. In the cohort of patients for heart transplantation here in Pitie Salpetriere Hospital, at least 25 to 30% of patients have terminal heart disease because they did not follow treatment advice that could have prevented terminal heart failure. This is crazy because it is easy to get medical care in France. There are countries where access to medical care is not easy. But in France. The cost of medical care for the patient is almost nothing. Everyone can go to a hospital in France. It is amazing, as France is ideal even among European health care systems. France has the most advanced healthcare. Physicians and patients in France have the highest satisfaction marks in health care in entire Europe. I agree. But even if it is easy to get medical care in France some patients are so much away from getting care, by socio-economical status or intellectual status, They don't think about medical care. They would not go to medical doctors. Even it is easy to go to medical doctors. But they will not go to the medical doctor. They do not understand that taking pills is very important. They do not understand that drinking ten beers a day is bad. They don't understand all that. I don't blame them. They maybe are not educated enough. This is a pity because when you see these patients coming to heart transplantation because previously they didn't have enough information, they did not get enough medical care to prevent terminal heart failure. This is something important that everyone should be able to understand. Yesterday I was discussing it with one of our cardiologists. He is a very good cardiologist. He is looking at public health indicators. He fully agrees with me on this topic. Even in Paris, in the greater Paris area, there are some parts of greater Paris were the quality of life of patients is not so good; the social, economic status of the patients is not so good. In those areas. The rate of heart failure is greater than in the center of Paris. Medical second opinion is important. This is important to me.