Heart Transplantation: Who Needs It And Why?

The heart is a muscular organ about the size of a clenched fist located in the middle of the rib cage. It works non-stop, pumping around 2,000 gallons of blood throughout the body on a daily basis, beating around 2.5 billion times circulating nearly 50–65 million gallons of blood over an average lifetime. If not cared for, factors such as high cholesterol, obesity and high blood pressure coupled with vices such as smoking and excessive consumption of alcohol can severely damage your blood vessels and your heart.

A heart transplant is a surgical operation wherein a severely damaged heart resulting in end-stage heart failure is replaced with a healthy donor heart. When the heart starts to fail, other vital organs are also affected. So, a heart transplant needs to be done before other organ damage starts. If a heart failure is not treated on time, it can lead to several complications while severely hindering your ability to perform any physical work. It could also cause intense breathlessness.

What Causes Heart Failure?

Being diagnosed with heart failure means that your heart is unable to pump enough blood to effectively cater to your body’s needs. However, this doesn’t mean that your heart is about to stop it simply means that the main pumping chambers in your heart have become too stiff and can no longer pump with adequate force or that your heart is no longer able to fill itself up with enough blood between beats. Heart failure can either affect both sides or only one side of the heart. The most common conditions that cause cardiac failure are:

• Coronary artery disease

• High blood pressure

• Leaking or blocked valves

• Cardiomyopathy

• Viral cardiac infections

• Inherited forms of cardiac disease

• Congenital cardiac disease

• Children administered certain medicines for leukemia

• Women whose hearts have been weakened by pregnancy/childbirth

Suitability Factors For Heart Transplant

A team of heart transplant surgeons will initially assess your eligibility for a heart transplant. You will then be explained about the risks involved. They will also evaluate your medical history, test results, social history, and conduct psychological tests to analyse where and how you might need support during and after your surgery. If you are deemed suitable and are willing to have a heart transplant, you will be put on the waiting list. Most often, a heart is donated based on the level of urgency and according to the severity of one’s medical condition.

The donated heart will be from an individual who has recently passed away and is an organ donor or whose family has agreed to donate their heart. When a heart becomes available for donation, factors such as whether it matches your blood group, your weight and size will be taken into consideration. Further, your other organs, such as the kidneys and liver, should also be working normally in order to be eligible for a donation.

How Is The Surgery Performed?

Once you are ear-marked for donation, things move along pretty quickly. A wide array of tests will be performed before the procedure. You will also be asked for an informed consent a mandatory requirement before the procedure is performed. Post the tests, if all your levels are acceptable, you will be wheeled into surgery and placed under general anaesthesia for the entirety of the procedure. A typical heart transplant takes anywhere between 5 to 7 hours.

There are two types of heart transplants:

Orthotopic transplant: The most common type, this procedure involves removing the diseased heart and replacing it with the donor’s.

Heterotopic transplant: A slightly rarer procedure, this involves attaching the donor’s heart to the old heart, where the donor’s heart doubles up as an assist pump.

Post-surgery, you will be confined to the ICU and monitored closely. You will also be put on anti-rejection medication which must be continued lifelong. Additionally, you will be closely monitored by specially trained medical and nursing staff including dieticians, pharmacists and physiotherapists. Regular blood tests, chest X-rays and ECGs will also be done to ensure that your body is not rejecting the donor organ.

Life After Heart Transplant Surgery

While every patient is different, most report feeling better after a heart transplant. After your discharge, you will be required to attend all necessary medical appointments to protect your new heart. You will also be needed to adhere to any health and lifestyle advice given to you by your physician while participating actively in rehabilitation and exercise programmes. This is referred to as cardiac rehabilitation and is most beneficial.

The ultimate goal of our heart transplant surgeons is for you to return to a normal lifestyle, so that you can be physically and socially active, resume work and enjoy a better quality of life. You should take extra precaution and avoid exposure to germs that could cause illness, as your immune system is weakened a bit by the anti-rejection drugs.

Heart Failure Management

Before suggesting a heart transplant, the cardiac team will attempt to medically manage heart failure in patients with the latest available medication to control progression of the condition. Also, the cardiac rehabilitation team will counsel the patients and their family members on diet and other lifestyle modifications to limit symptoms and to optimise the patient’s ability to participate in daily routines.

Diet & Lifestyle measures

• Moderate physical activity (if symptoms are mild)

• Bed rest (if symptoms are severe)

• Weight reduction and weight monitoring

• Restricted salt intake

• Fluid restriction

Pharmacological (Drug) Management

• Diuretics to improve urine output and eliminate fluid in the lungs

• Angiotensin receptor antagonist slows the deterioration of heart function

• Beta blockers decreases the amount of work on the heart

• Positive inotropes improves heart function

• Digoxin to make the heart beat stronger and with a more regular rhythm

• Dobutamine stimulates the heart muscle and improves blood flow

• Milrinone to increase the heart’s contractility and decrease pulmonary vascular resistance

• Levosimendan a calcium sensitiser

ECMO or Cardiac Revival Programme

ECMO is an aggressive form of life support that pumps blood out of a patient’s body, oxygenates it and then returns it back to the body. The technology can keep a person alive for months, even if their heart and lungs aren’t working.

Mechanical Circulatory Support (MCS)

A mechanical circulatory support (MCS) device helps your heart function when it is not working at its best. MGM Healthcare offers the latest technology and most advanced heart support options in ventricular assist devices (VAD) and total artificial hearts for individuals who need MCS. The second, third and soon fourth-generation MCS devices we use are much smaller, more efficient, safer and easier to implant.

Our experienced doctors work with every type of MCS device available today and offer minimally invasive approaches. They are also involved in new research to continually improve treatments. Our lead heart surgeon was the first in India to successfully implant and use a VAD on a patient awaiting a heart transplant.

Who needs an MCS device?

Some individuals may need short-term MCS support prior to a heart transplant, while others may need more long-term support.

You may need an MCS device for:

Bridge-to-transplant: An MCS device can help you while you wait for a donor heart, which can take time. It takes over the work of your heart prior to a heart transplant.

Long-term destination therapy: If you are not a candidate for transplant or surgery, these devices can support your heart long-term.

Types of MCS devices:

We specialise in two types of MCS devices:

Ventricular assist devices (VAD): These devices take over the function of one of the ventricles in your heart. They take blood from the chambers of the heart and help pump it to the body, supporting the heart. In this there are two types, left ventricular assist device (LVAD) and right ventricular assist device.

Total artificial heart (TAH): This device replaces the function of both ventricles in people with end-stage heart failure.

Left Ventricular Assist Devices: A bridge to Transplant

Heart failure is a complex condition that causes the heart to struggle with its workload, significantly impacting one's daily life. In advanced cases, the weakened left side of the heart leads to extreme fatigue and weakness, hindering routine activities. However, advancements in medical technology, including the innovative Left Ventricular Assist Device (LVAD), present a glimmer of hope for those seeking to resume a normal and fulfilling lifestyle.

Causes of heart failure:

Heart failure can be caused by multiple factors, including coronary artery disease, diabetes, high blood pressure, obesity, heart valve problems, muscle disorders, inflammatory conditions and congenital defects. If left untreated, heart failure can greatly impair the functioning of the heart's left side, resulting in hindered circulation of vital oxygen-rich blood.

The role of LVAD:

The LVAD is an implantable pump designed to assist individuals with advanced heart failure. Its specialized design supports the left side of the heart with exceptional efficiency, aiding in blood circulation and serving as an interim measure before transplantation. The Institute of Heart and lung transplant and Mechanical Circulatory Support stands at the forefront of LVAD treatment, providing comprehensive care and support to patients.

Reclaiming Daily Life with LVAD:

Studies reveal a remarkable 94% success rate in patients undergoing the LVAD procedure and this effectiveness is demonstrated through a six-minute walking test over six months, emphasizing the safety and efficacy of this life-changing procedure.

Equipped with an LVAD, patients can resume daily activities like walking, gardening, dancing, and spend quality time with their families. Caregivers are trained to respond to alarms from the device and interpret LVAD readings, ensuring a smooth transition into an active lifestyle.

Design mechanism of LVAD:

LVAD's advanced engineering includes efficient power management with two sets of batteries for day-time activities. The heart pump, connected to the left side of the patient's heart, and the driveline, facilitating

power and information transfer, allowing the heart to pump blood effectively. This ensures continuous support for patients on their journey to recovery.