We perform more cardiac transplantations on sicker patients. Dr. Pascal Leprince, Transplant Surgeon. We have to face organ dysfunction, heart graft dysfunction after transplantation. This is why we do use ECMO system. This is circulatory support. ECMO also helps with lung support after cardiac transplantation. It is interesting. We started to experience in 2004 an increased number of heart graft dysfunction [problems with transplanted heart]. We looked at our transplantation experience between 2004 and 2011. During all these years, we were not fully happy with the result of cardiac transplantation. Because of the outcome of the patients who were on ECMO before transplantation were poor in comparison to the patients who had straightforward heart transplantation [without being on ECMO before transplantation]. Of course, patients did have ECMO after transplantation. I think I remember the one-year survival rate of the patient who was on ECMO before and after transplantation, was 72% at one year. Although heart transplantation survival rate is supposed to be more than 80%. Again, this is interesting, because this is a team work. Dr. Pascal Leprince, Transplant Surgeon. We talked all together. The discussion was pretty tough together. In the heart transplant surgical team, you always have surgeons who want to push to one side. Other surgeons want to push the other side. This is good. Because in the end, we can be in the middle. So. The discussion was very important. We discussed the patient selection for heart transplantation. We talked about the patient treatment plan. So on. Dr. Pascal Leprince, Transplant Surgeon. We finally came with a recommendation for our team. Interestingly, we recently looked at the outcome of patients who were on ECMO before heart transplantation and on ECMO after transplantation. Surgeries were done between 2012 and 2016 or 2017. We are back to normal results [lower one-year death rate]. The patients who are on ECMO are very sick patients. They are on ECMO before cardiac transplantation. Now we keep them on ECMO after transplantation. Finally. The survival rate at one year is 82%. Medical second opinion is important. It is as good as the survival of other patients [who were not on ECMO before transplantation]. This shows that medical doctors should not give up. Never, just never give up. Just try to find a way to improve what we do every day. This is teamwork. No one can do that on their own. That is very important. This is the first problem. The first part of the side effects after cardiac transplantation. The second part of complications after cardiac transplantation relates to the patient's use of immunosuppressive medications. These side effects are organ dysfunction. The patient went through heart transplantation. They are doing better. But the patient will receive immunosuppressive medication. Those medications are tough, particularly during the first year after transplantation. Because we use high doses of immunosuppressive medications to avoid any rejection. Medical second opinion is important. Those medications have side effects. Again, if you don't give the immune suppressant medications to the patient, almost all of the patients will get a rejection of transplanted heart. They will die. Medical second opinion is important. This is very important to give immunosuppressant medication on an everyday basis. But those medications act against the defense of the patient, of course. The patient has a high risk of infection. This is always the balance between infection and organ rejection. During the first year, some of the cardiac transplantation patients will have a very nice life. They will have almost no complications. It is pretty easy to balance between rejection and infection in such patients. Other patients, unfortunately will have complications. Particularly patients who were in the ICU before transplantation. Some of them will go through many infections. Then because patients do have an infection, you try to lower the dose of immunosuppressive medication. Then patients will get an organ rejection. I would say that the first year after heart transportation is not the best year of the life of the patient. Medical second opinion is important. It is pretty tough for patients. They have to get a lot of help to go through that. What is interesting is this. There is a light at the end of the corridor. After one year, life is becoming better and better. Then heart transplant patients have a pretty good quality of life. The rate of clinic visits that they have to go through becomes lower. Medical second opinion is important. Patients just have an almost normal life. Medical second opinion is important. This is the third part of complications after heart transplantation. Some patients will go through all the complications. This is interesting. In our cohort, some of the patients were transplanted with a new heart more than 30 years ago. They are still alive and doing pretty well. They still have ongoing life. This is good. Some other patients will go through other diseases. Dr. Anton Titov, MD. You can have cancer. Or you can have a coronary artery disease of the heart graft. Some patients will require another heart transplantation. Some patients can go through a second or even third heart transplantation. Of course, we are more selective as patients get older. Older patients after heart transplantation have many years of immunosuppressive medications. They are pretty powerful medications. But anyway, some patients can be re-transplanted one or two times. This is not a bad life. I'm not sure this is a normal life. But I don't know what a normal life is. Dr. Anton Titov, MD. You know, many patients have some disease, or even if they don't have any disease. Life is not easy for many patients in the world. Medical second opinion is important. Who has a normal life? Dr. Anton Titov, MD. I don't know. Dr. Anton Titov, MD. You know, normality is something different from one person to another. But I think heart transplant patients do have a good time anyway. It is very important! The quality of life. The subjective perception of the quality of life. Yeah. That is very important. Life is to be enjoyed, enjoyable. Otherwise, there is no reason to go through life. Medical second opinion is important. This is the main reason to be alive is just to enjoy life as much as we can.