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When heart transplant is not a possibility, how do you save a life?

  • 41 year old ‘Machine man’ fought death 13 times to get a new life with a Left Ventricular Assist Device (LVAD)
  • 71 year old, India’s first LVAD (Heart Mate III) patient completes two successful years of implant
  • Journey from LVAD to a heart transplant – “bridge to a transplant” and “Destination Therapy”

Organ donation in India continues to be a dismal scenario and for patients with end-stage organ failure, it is often a painful and endless wait to find relief. With 70% of India’s 1.4 lakh accident victims diagnosed as brain dead every year, the country has 80,000 potential organ donors. Yet, organs from only about 100 are retrieved, making the percentage of cadaver donations a dismal 0.3%. In heart transplants in particular, in Delhi-NCR itself, only one heart donation was reported in 2012, none in 2013 and two in 2014, making it an abysmal total of 10 heart donations reported in 3 years. So the big question before medical science has been – is there an alternate solution that can help save a life, in the absence of an available organ for transplant?

L to R - Dr Kewal Krishan, Director-Heart Transplant & Ventricular Assist Devices, Principal Consultant

Against this backdrop, comes the story of 41year old Shubhankar Dhar Choudhary, whose life came to a screeching halt one day in February 2015. What began with nausea and breathlessness, soon turned into repeated episodes of vomiting, severe perspiration and dizziness, and within a few days, he was intubated. Even on the ventilator, his condition continued to rapidly deteriorate and within two days, he suffered multiple organ failure. His liver, kidneys, lungs and heart had deteriorated and his family was desperately looking for a ray of hope. Shubhankar had been fitted with a pacemaker two years ago. And his was a situation where the heart was so weak that it could neither wait for a donor nor an artificial heart.

Dr. Kewal Krishan, Director- Heart Transplant and Ventricular Assist Devices, Principal Consultant – CTVS, Max Saket who treated Shubhankar shared how in end-stage heart failure, the only options were either a heart transplant or Ventricular Assist Device (LVAD). However, every time Dr. Krishan and his team tried to wean the mechanical support that the patient was on, his condition would start deteriorating. As a result, Shubhankar could not wait for a new heart.  In a case like his, Left Ventricular Assist Device (LVAD) came as a bridge to transplant, prolonging his life enough to be able to receive a transplant. On the operating table, it was a decision made within four hours to choose LVAD over certain death, and the skilled treating team at Max Healthcare, implanted HeartMate II, over six hour surgery.

Some critical statistics
Death by heart failure Killing 1.7 million Indians in 2016, up 53% from 2005 – the leading cause
Young India at higher risk
  • 40% Indians who develop heart attack are under the age of 55
  • Out of those who die because of heart attack, 50 per cent die suddenly (sudden cardiac death)
  • Smoking , family history of CAD , diabetes , high blood pressure , high bad(LDL) cholesterol , low (HDL)good cholesterol obesity are the risk factors
Indians at higher risk
  1. Indians are at a 3- 4 times higher risk of developing coronary artery disease (CAD) compared to the US population
*Source: Industry statistics

In the case of end-stage heart failure when a person’s heart is too weak to effectively pump on its own or has undergone an open-heart surgery, avoiding undergoing a Total Artificial Heart Transplant (TAHT) can be the difference between life and death. Unlike TAHT, where the native heart is replaced with an artificial heart, an LVAD is placed in one of the heart chambers in the patient’s chest and helps the heart pump oxygen-rich blood throughout the body.  Shubhankar adjusted to the new device and all its constraints –dependence on an external battery unit, certain lifestyle modifications and restrictions; and proudly went back to work with the title ‘Machine Man’. Today, his story has come full circle, with him receiving a cadaveric heart via a Green Corridor.

Shubhankar’s case is a prime example of the growing incidence of cardiac failures among an increasingly younger population, with nearly 2.6 million Indians predicted to die of cardiovascular diseases by 2020. An extremely poor rate of cadaver donations and months of waiting to receive a heart results in the death of most patients who manage to make their way into the waiting list.

Even more difficult is the situation of those patients whose lifestyle conditions, age factors etc make them unfit to receive a transplant. Such was the case of 71-year old Mr. R.P. Garg, the first receiver of Heart Mate III LVAD implant in India in 2016.

Mr. Garg was brought to Max Super Specialty Hospital, Saket with condition of heart failure, deep vein thrombosis and clot in the right ventricle, in 2016. At the time, his treating doctor had predicted end stage multiple organ failure on high support and symptoms of certain death. LVAD worked as a destination therapy for him, solving the need of a transplant. Today, at 71 years of age, he is completing two years of successful implant and has not had a single episode of hospitalization after the initial 20-day post-operative recovery period.

 “India has a long way to go before we can match the demand for heart transplants in the country. There is a dire need to aggressively spread awareness about the colossal gap that exists between the organ donors and those who need it in India. Though there are more than 10 lakh people suffering from end-stage organ failure, only around 3,500 organ transplants are performed every year. This scenario proves to be especially fatal for those who are battling with end-stage heart failure and can’t wait for a heart to be available. LVAD for these patients is a blessing in disguise.” said Dr. Kewal Krishan, Director-Heart Transplant and Ventricular Assist Devices, Principal Consultant – CTVS, Max Saket “Medical therapy and surgery may help patients with chronic heart conditions, but significant number of these patients continue to progress and develop end stage heart failure. Once medical therapy is deemed a failure or in patients who have already undergone cardiac procedure and are still symptomatic, cardiac replacement therapy like heart transplant or ventricular assist device can often be the only solution. LVAD has proven to have a nearly similar success rate as a heart transplant” said Dr. K.K. Talwar Chairman – Cardiology, Max Healthcare

Dr. Rajneesh Malhotra, Director – CTVS, Max Saket said “Heart failure is often a long-term (chronic) condition, but it can sometimes develop suddenly. Many of the young professionals today have odd working hours that leads to stress, and not many of them have healthy eating and exercise habits. On top of it, excessive alcohol consumption and smoking worsens the situation. Such a lifestyle results in high blood pressure, obesity, diabetes and coronary artery disease further leading to heart ailments.”  

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