Heart Transplant- Only Center in Gujarat currently performing Heart Transplants actively.

Because of awareness to organ donation in India, treatments for heart failure and heart transplants are increasing across the country.

Marengo CIMS Hospital in Ahmedabad achieved one of the rarest of feats by doing the 1st heart transplant surgery in Gujarat.Marengo CIMS Hospital has crossed 9 successful heart transplants as of June 2019.

What is a heart transplant?

A heart transplant  is  a surgery to  remove  a damaged or diseased heart and replacing it with a healthy donor, performed on patients  with  end stage  heart  failure  or  severe  coronary  artery  disease heart when other  medical or  surgical  treatments  have  failed. It  is  not  considered  to  be  a  cure  for  heart  disease,  but  a  life-saving  treatment  intended  to  improve  the  quality  of  life  for the  recipients.

What is heart failure?

Heart  failure  occurs  when  the  heart  is  unable to  pump enough  blood to  meet the  needs  of  the body. The typical symptoms  of  heart  failure  are  shortness  of  breath,  poor  exercise  tolerance, cough (especially at night), fatigue, and fluid retention. If heart failure symptoms  and  heart  function  cannot  be  improved  by  medications  or  surgery, heart  transplant  may  be beneficial.

Marengo CIMS Hospital is known as the best heart failure hospital in Ahmedabad and recognised amongst the top heart failure hospitals in the world.

How is heart failure diagnosed?

Heart failure is diagnosed based on patient’s medical and family histories, a physical exam, and test results. The signs and symptoms of heart failure also are common in other conditions.

• The cause of heart failure is evaluated such as coronary heart disease (CHD), high blood pressure, or diabetes
• Other causes of patient’s symptoms are evaluated
• Find any damage to patient’s heart and check how well patient’s heart pumps blood
• Early diagnosis and treatment can help people who have heart failure live longer, more active lives.

After medical and family histories and physical exam, patent has to undergo certain tests.  There are main 2 very simple tests that are primary – an echocardiogram and a blood test called NT-pro BNP (a hormone that rises in the blood as a response to a failing heart). The echocardiogram will measure the Ejection Fraction or EF which is a measure of how well the heart is contracting. BNP Blood Test checks the level of a hormone in patient’s blood called BNP. The level of this hormone rises during heart failure. Other tests are  ECG (Electrocardiogram), Chest X-Ray, Doppler Ultrasound, Holter Monitor, Cardiac Catheterization, Coronary Angiography, Stress Test, Cardiac MRI and  Thyroid Function Tests, which are done as and when needed.

Why is heart transplant performed?

Heart  transplant  is  indicated  in  those  who’ve experienced  heart  disease  or  heart  failure  due  to  a variety  of  causes,  including:

• A congenital  defect
• Coronary artery  disease
• Valvular heart  disease
• A weakened  heart  muscle,  or  cardiomyopathy

Marengo CIMS Hospital is the best heart transplant hospital in Ahmedabad and Gujarat and we have the highest volume for heart transplants in Gujarat with a 100% success rate for the transplant.

How is a heart transplant performed?

A heart transplant is carried out under general anaesthesia and normally takes between four and six hours. The  transplant  should  be  performed  within  2  hours  from  the  brain  death. Patent is connected to a heart-lung bypass machine, which will take over the functions of the heart and lungs while the transplant is being carried out. Marengo CIMS Hospital is the best heart transplant center in Ahmedabad, Gujarat and perhaps even in India with one of the highest heart transplant success rates across the country.

The procedure:

• The surgeon makes a cut (incision)  down the chest of  the patient  over  breastbone and the bone is separated, allowing the surgeon to access the heart
• Then the heart is removed, leaving behind a section of the right and left atria, the two upper chambers of the heart
• The new heart is connected to the aorta, the main artery from the heart, the pulmonary artery, and the remaining part of the atria
• The bypass machine should be taken off when the new heart starts beating.
• The breastbone will be closed with metal wires, and the tissues and skin will be closed with stitches.

After the operation

Once the transplant is complete, the patient will be moved to an intensive care unit (ICU). A machine called a ventilator will assist in breathing, and a tube will be inserted into a vein to provide with fluid and nutrients. These will normally be removed after a few days.

Pain relief is also provided as required.

Most people are well enough to move from the ICU and into a hospital ward within a few days.

Patient will be able to leave hospital within two or three weeks, although they need to have regular follow-up appointments and take medication to help stop their body rejecting patient’s new heart.

What are the risks associated with Heart Transplants? 

A heart transplant is a major operation, and there is a risk of several complications.

Some complications can occur soon after the procedure, while others may develop months or even years later.

The main risks associated with a heart transplant are described below.

1. Rejection

This is where the immune system recognises the transplanted heart as foreign and attacks it. Rejection usually occurs in the days, weeks or months after the transplant, although it can sometimes happen years later. Immunosuppressant medication can reduce the risk of this happening, but can’t always prevent it completely.

2. Graft failure

In this the donated heart fails and doesn’t work properly. It occurs in 5-10% of people who’ve had a heart transplant, and can be fatal.

3. Immunosuppressant side effects

The immunosuppressant medications needed to prevent rejection can have a number of significant side effects.

4. Infections

Immunosuppressant medication will weaken patient’s immune system and make the patient more vulnerable to infection.

5. Narrowed arteries

Narrowing and hardening of the blood vessels connected to the donor heart is a common long-term complication of a heart transplant.

Outcome after first heart transplant

Cardiac transplantation remains the treatment of choice for many patients with end-stage heart failure (HF) with severely impaired functional capacity despite optimal medical therapy. Although barriers to long-term survival remain, the outcome among transplant recipients has improved over several decades as a result of careful recipient and donor selection, advances in immunosuppression, and the prevention and treatment of opportunistic infections.

Receiving  a  new  heart  can  improve  quality  of  life  considerably,  but  one  has  to  take  good  care  of  it.  In addition to taking daily anti-rejection medications, the recipient needs to follow a heart-healthy diet and lifestyle as prescribed by doctor.  This includes not smoking and exercising on a regular basis.

Survival 

Approximately  50 – 60% patient survive more than 12 years. Their results are as god as kidney transplant  Survival rates  for  people who’ve had a heart transplant  vary according  to  their  overall health status, but  averages  remain  high.  Rejection is   the main cause for a shortened life span.

Coronary Artery Bypass Surgery (CABG)

As a solution of blocked and narrowed vessel and compromised blood flow to heart due to it ,a graft is obtained from other part of the body and is attached  above and below the blockade so as to divert the blood flow.

Bypass could be performed in two ways:

On Pump CABG: It is also known as Open Heart Surgery. Heart’s and lung’s functions are replaced with a machine known as “Heart-Lung Machine”. The process of such replacement of function is known as extracorporeal (outside the body) membrane oxygenation (ECMO). The operator/technician responsible for handling and use of the equipment is known as perfusionist.

The heart-lung machine is made up of majorly three parts: a pump (either non-occlusive or occlusive roller pump), a blood oxygenator, and a blood warming device. Through plastic tubing, connection of these three parts with anatomical heart is made. Deoxygenated blood is pumped to oxygenator to remove carbon dioxide from blood. Oxygenated blood is thereafter pumped to respective artery/vein of the body.

Schematic block diagram for orientation of position of Heart Lung Machine:

Off-pump CABG:  Beating Heart Surgery

Another technique with advantage of lesser patient harm is known as off-pump CAB (OPCAB) as it doesn’t utilize any pump. It doesn’t require heart lung machine. The surgery is performed on beating heart that’s why it is called as “beating heart surgery” – a highly precise, complex and skill demanding procedure. We are proud that our cardiothoracic surgery team has exceptionally excelled in this technique and has shown continued commitment towards patient safety.

Minimally invasive coronary artery bypass

We also perform MICS-CABG which seems like a boon as according to name itself; it requires a very minimal invasion similar to that made using a key i.e. keyhole. We have great success in patients with Left Ventricular Ejection Fraction (LVEF) even less than 25% i.e. critical heart failure patients.

Implantable left ventricular assist device (LVAD):

An LVAD is a kind of artificial heart pump. It is used to treat people with severe heart failure and is sometimes given to people on the waiting list for a heart transplant. Normally, the left ventricle, one of the heart’s four chambers, pumps blood into the aorta (the large artery leaving the heart) and around the body. In the event that someone has severe heart failure, the heart is too weak to pump enough blood around the body. Some patients being considered for a heart transplant may need to have an LVAD implanted if they are unlikely to survive until a suitable donor heart becomes available. The device helps the failing heart and aims to restore normal blood flow.

Left Ventricular Reconstruction

After a heart attack in the left lower chamber of the heart (left ventricle), scar tissue will form in the left chamber.  As the time passes this scar tissue can weaken and thin out to become an aneurysm–an abnormal bulge of tissue. This aneurysm–in conjunction with other heart problems–can cause the heart to enlarge, reducing its ability to pump blood effectively, resulting in heart failure.

In a ventricular reconstruction surgery, surgeons remove part of the aneurysm scar tissue to reshape the heart and restore it to its normal, conical shape. Typically, a small patch is sewn into place where the aneurysm once was. With the patch in place, surgeons sew tissue over the patch. Other procedures, such as valve repair or coronary artery bypass may be performed during the ventricular reconstruction operation.

CIMS Cardiothoracic surgery unit has established a dedicated unit for surgical /interventional procedures for valvular diseases including left atrial appendage ligation and electro cautery maze. The diseased valves could be either repaired or replaced based on its diseased condition’s severity and surgery recommendations.

CIMS Valvular clinic has both repairs and replacement solutions for:

• Mitral Valve (Common problems are Mitral Regurgitation and Mitral Stenosis)
• Tricuspid Valve
• Aortic Valve (Common problems are Aortic Stenosis and Aortic Regurgitation)
• Pulmonic Valve

Latest technologies like Left Atrial Appendage Occlusion (LAAO) Device and MitraClip are also considered to be future of CIMS valvular clinic.

Septal Defects:

It is a disorder where due to abnormality (majorly hole in septum separating two chambers of ventricles), a portion of blood from one chamber enters to another. Thus, it is sent back for oxygenation even after being oxygenated. This causes increase in load to heart and also causes gradual damage to lungs.

Tetralogy of Fallot:

It is a group of four diseased conditions in the heart, which is a congenital abnormality. It is characterized by the following: a large ventricular septal defect (VSD), pulmonary stenosis, right ventricular hypertrophy and an overriding aorta.

As a solution of blocked and narrowed vessel and compromised blood flow to heart due to it ,a graft is obtained from other part of the body and is attached  above and below the blockade so as to divert the blood flow.

Pediatric Cardiac Surgeries

We have unique expertise in surgical management of paediatric cardiac diseases and/or congenital cardiac diseases with full time availability of paediatric cardiologists, paediatric cardiac surgeon and latest diagnostics technologies including fetal echo.

Aortic surgery

CIMS cardiothoracic surgeons treat diseases on ascending aorta, aortic arch, descending aorta including thoracoabdominal repairs, thoracic and abdominal aorta endovascular stent graft procedures which are all performed by a multidisciplinary surgical team.

For ascending thoracic and abdominal aorta aneurysms, a minimally invasive endovascular approach is becoming the preferred method, decreasing morbidity and mortality in these patients when performed by a skilled team. We use the endovascular approach for thoracic aorta aneurysm surgery.

MAZE Procedure for Treatment of Atrial Fibrillation

Atrial Fibrillation (AF) is an abnormal heart rhythm where the upper chambers of the heart contract in an uncoordinated fashion and start rapid and irregular beating. AF is dangerous because it may cause blood to pool in these chambers. The pooled blood can lead to clumps of blood called blood clots. A stroke can occur if a blood clot travels from the heart and blocks a small artery in the brain.

Maze surgery cures AF by creating a “maze” of new electrical pathways to let electrical impulses travel easily through the heart. Our team recommend Maze surgery if AF cannot be treated with medicines or other treatments. During the procedure, a number of incisions are made on the left and right atrium to form scar tissue, which does not conduct electricity and disrupts the path of abnormal electrical impulses. The scar tissue also prevents erratic electrical signals from recurring. After the incisions are made, the atrium is sewn together to allow it to hold blood and contract to push blood into the ventricle.

Hypertrophic cardiomyopathy surgery – septal myectomy

Septal myectomy is the gold-standard therapy for hypertrophic obstructive cardiomyopathy (HOCM).  The surgery entails removing a portion of the septum that is obstructing the flow of blood from the left ventricle to the aorta. Septal myectomies have been successfully performed for more than 25 years. The alternatives to septal myectomies are treatment with medication (usually beta or calcium blockers) or non-surgical removal of tissue with alcohol ablation. Ordinarily, septal myectomies are performed only after attempts at treatment with medication fail.