Centre of Excellence for Cardiac Surgery in India
- Our state of the art hospitals in India have a 99.5 % success rate of performing most complex cardiac surgeries at the most affordable cost compared to similar modern facilities anywhere in the world.
- Highly Experienced and skilled US/UK Board certified team of heart surgeons and cardiologists work together to provide comprehensive, multidisciplinary care to patients suffering from heart diseases
- State of the art infrastructure, cutting edge technology providing care to patients Our doctors, nurses, technicians and heart experts bring the promise of unparalleled excellence in patient care
- Most Advanced Operation Theatres / Robotic surgery suite - State of the art equipment and monitoring devices necessary to successfully perform complex heart bypass, percutaneous valve surgeries, complex hybrid aortic aneurysm interventions and minimally invasive cardiac operations.
Centre of Excellence for Heart Failure Management and Heart Transplant in India specializes in Heart Failure Management and Heart Transplant apart from being a Ventricular Assist Device (VAD) Destination Therapy Center, a bridge to a transplant incase it is required later.
The comprehensive heart disease management programme also includes preventive measures to avoid Heart Failure, Cardiopulmonary testing including peak oxygen consumption measurement, ECMO (lung heart machine) as a bridge to a transplant or a bridge to a decision, nutritional counselling designed to help patients adhere to a complex medical regimen and a specialized low-sodium (salt) diet. In addition, patients learn to recognize fluid retention, that signals heart failure. They are counselled on aspects of Cardiac rehabilitation and individualized exercise plans are drawn up for them to strengthen their heart muscle, improve blood circulation and support the recovery process.
Cardiac Transplant team at HealtTripToIndia affiliated heart hospital has so far performed 35-ECMO, 16 heart-transplants, 5-VAD’s and is credited with India’s first successful implantation of Heartmate II LVAD and HVAD, a mechanical artificial heart pump.
The entire team of physicians, coordinators and nursing staff are highly trained individuals with many years of experience in the field of transplant and heart failure management providing pre-operative, peri-operative and post-operative care.
Heart transplant in India
Heart transplant has long been the mainstay of end stage heart failure patients before the advent of high quality LVAD. The lower number of donor hearts is insufficient to fulfill the existing demands. The procedure involves open heart surgery in which the patient under general anesthesia is plugged into the heart lung machine through which the blood circulation is maintained.
The donor heart comes from the cadaver. The diseased heart is isolated from the main arteries and veins and then removed and the blood vessels are ligated. The donor heart is placed in the cavity and the blood vessels are reconnected to the new heart. Once the heart resumes pumping and the blood pressure is restored, the patient is disconnected from the heart lung machine. The patient is put on lifelong medications to avoid rejection and regular check-ups are advised. The procedure takes several hours. A significant number of recipients survive more than 10 years after the procedure.
Congestive heart failure (CHF)
Heart failure, also called congestive heart failure, or CHF, is a condition that occurs when the heart is unable to pump blood sufficiently. End-stage heart failure is a disease in which the heart muscle is failing severely in its attempt to pump blood through the body, and in which all other available treatments are no longer helping to improve the heart's function.
Heart transplantation is generally reserved for patients with end-stage congestive heart failure (CHF) who are estimated to have less than 1 year to live without the transplant and who are not candidates for or have not been helped by conventional medical therapy
In adults, heart failure can be caused by the following reasons:
- Coronary artery disease
- A weakening of the heart muscle (cardiomyopathy)
- Valvular heart disease
- Congenital heart defect — a heart problem one is born with
- Failure of a previous heart transplant
Before the Heart Transplant Procedure
The patient needs to be eligible for a transplant. The evaluation will check to see the following:
- Blood or skin tests to check for infections
- Tests of the kidney and liver)
- Tests to evaluate the heart, such as EKG, echocardiogram, and cardiac catheterization
- Tests to look for cancer
- Tissue and blood typing, to help make sure the patient’s body will not reject the donated heart
If medical therapy fails to support the vital organs as one waits for a donor heart, the doctors may recommend the patient to have a device implanted to support the heart while waiting for a donor organ. These devices are known as ventricular assist devices (VADs). The devices are also referred to as a bridge to transplantation because they gain some time until a donor heart is available.
Experts list three major advantages of the absorbable scaffolding. There is no question of stent thrombosis (clotting) because the scaffolding dissolves. The biggest advantage is that patients will not need to take two anti-platelet (blood-thinning) medicines for years on end. Cardiac patients across India now have a new option while seeking treatment for their hearts. They can ask for a bio-absorbable stent, which will completely disappear some 18-odd months after it's fixed in their blocked blood vessel. At present, metallic stents that permanently stay in the blood vessel are the most-sought-after treatment for cardiac diseases.
Transplantation procedures
During the cardiac transplantation procedure, the ventricles are excised, leaving the great vessels, right atrium, and left atrium of the recipient. The donor heart is then sewn to these areas. A cardiac allograft can be sewn in either a heterotopic or an orthotopic position.
Orthotopic heart transplantation
The more common of the two procedures, the orthotopic approach, requires replacing the recipient heart with the donor heart. The donor heart is trimmed to fit onto the patient's remaining left atrium and the great vessels are stitched in place. The new heart is restarted, the patient is weaned from cardiopulmonary bypass and the chest cavity is closed.
Heterotopic heart transplantation
Heterotopic transplantation is applicable to patients with severe pulmonary hypertension. In the heterotopic procedure, the patient's own heart is not removed. The new heart is positioned so that the chambers and blood vessels of both hearts can be connected to form what is effectively a 'double heart'. The procedure can give the patient's original heart a chance to recover, and if the donor's heart fails (e.g., through rejection), it can later be removed, leaving the patient's original heart.
Ventricular Assist Devices (VADs)
Left ventricular Assist Device or Ventricular Assist Device was once considered as a stop gap arrangement or a bridge to transplant in patients for end stage heart failure who were waiting for heart transplant. With advancement in medical technology, the quality of LVAD has improved to such an extent that patients have shown improvement in quality of life to a great extent
The LVAD is surgically implanted just below the heart. One end is attached to the left ventricle -- that's the lower chamber of the heart that pumps blood out of the lungs and into the body. The other end is attached to the aorta, the body's main artery. Blood flows from the ventricles into the pump which passively fills up. When the sensors indicate it is full, the blood is ejected out of the device to the aorta.
A tube passes from the device through the skin. This tube, called the driveline, connects the pump to the external controller and power source.
The pump and its connections are implanted during open-heart surgery. A computer controller, a power pack, and a reserve power pack remain outside the body. Some models let a person wear these external units on a belt or harness outside.
The power pack has to be recharged at night.
Benefit of LVAD involves restoration of blood supply to the heart and other vital organs, time to rest for the heart, reduced fatigue and discomfort.
Side effects include infection, internal bleeding, heart failure, kidney failure, stroke, device failure, blood clot and respiratory failure.
Ventricular Assist Devices (VADs) are implantable mechanical heart pumps. They have been used in recent times to sustain patients who are candidates for heart transplant as they await a donor heart and are increasingly being used as a substitute for transplantation. Emerging research shows that VAD patients find that their hearts actually improve with help from these mechanical pumps.
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