Heart transplantation (replacement of a damaged heart with a normally functioning heart) is done when heart function is severely decreased and it is expected that patient will not live long with ongoing treatment.
Indications for heart transplantation:
Normally when heart pumps, it will eject 60-70% blood in it. This is called ejection fraction. However many conditions can damage the heart muscle so that it ejects less and less. This will result in heart failure. Heart Failure is a condition where in heart is not able to pump blood to meet the needs of the body.
- Severe heart failure not responding to standard medical or surgical therapy. The commonest condition that damages heart muscle is-heart attack. Following major or repeated heart attacks, a large amount of heart muscle dies, resulting in heart failure. The second commonest cause for heart failure ending up in heart transplantation is cardiomyopathy (damage to heart muscle from unknown causes). Other rare indications for heart transplantation include postpartum cardiomyopathy, alcoholic cardiomyopathy, and damage to heart muscle from valve problems or birth defects.
- If patient has extensive blocks in the blood vessels that take blood to the heart (coronary arteries) and has severe chest pain not responding to medicines and angioplasty or bypass surgery is not possible.
- Recurrent ventricular arrhythmias (rhythm disturbances) of heart not responding to medical or surgical therapy.
These patients with heart failure often present with increasing breathing difficulty even on minimal exertion, swelling of feet, low blood pressure needing repeated admissions. Once the doctor decides that patient has one of the above problems and patient is unlikely to live for more than one to one and a half years, then Heart Transplant option is discussed with patient and family. After they accept, we do a series of tests to see the fitness of the patient for this major surgery and if patient (recipient) is found fit, wait listed for transplantation.
Once a suitable brain dead person (donor) with blood group and size compatibility is found by the coordinating agency, preliminary tests are done to the donor to make sure that donor heart is working normally. One surgical team will go to the hospital where donor is available and harvest the heart and will bring to the hospital where recipient is ready in the operating room. Normally success rate is high if heart is transplanted within 4 hours of removing from the donor. New equipment is now available where heart can be kept alive for more time so that heart can be transported to longer distances.
After the surgery, patient is put on drugs that reduce immunity so that his/her body will not reject the organ. There are two main problems in the postoperative period- rejection of the organ by the body if immunosuppressive drugs dosage is not adequate and infection if the immunity is suppressed too much. 10 year survival after transplantation is around 75%. The longest living recipient after heart transplantation is living for more than 35 years.
First successful human to human heart transplantation was done on 3rd of December, 1967 in South Africa by Dr. Christiaan Barnard. As per International Society for heart and lung transplantation (ISHLT), so far over 100000 heart transplants, over 40000 lung transplants and over 4000 combined heart and lung transplants are done in the world.
First successful heart transplant in India, was done by Prof Venugopal on 3rd of August, 1994 at All India Institute of Medical sciences, New Delhi. Dr. A.G.K.Gokhale did the first successful heart transplant at Global Hospitals, Hyderabad on 6th of February 2004 in the states of Telangana and Andhra Pradesh. Nearly 25 heart transplant surgeries are performed by Dr Gokhale and team in both states of Telangana and Andhra Pradesh.