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A Change of Heart: The Tryst Between Indian Surgeons and Heart Transplants

1. Since the first successful heart transplant in India in 1994, over 350 have been performed. The surgery involves removing the diseased heart and replacing it with a donor heart while the patient is on a heart-lung machine. 2. The first human heart transplant was performed in 1967 in South Africa by Dr. Christian Barnard. The recipient, Louis Washkansky, survived 18 days after receiving the heart of a brain-dead donor. 3. Heart transplants in India have continued to increase, with advancements like the first one performed in Kolkata in 2018. The future holds promise for more donors and better outcomes through new technologies and understanding of rejection.

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Juhi Neogi
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53 views

A Change of Heart: The Tryst Between Indian Surgeons and Heart Transplants

1. Since the first successful heart transplant in India in 1994, over 350 have been performed. The surgery involves removing the diseased heart and replacing it with a donor heart while the patient is on a heart-lung machine. 2. The first human heart transplant was performed in 1967 in South Africa by Dr. Christian Barnard. The recipient, Louis Washkansky, survived 18 days after receiving the heart of a brain-dead donor. 3. Heart transplants in India have continued to increase, with advancements like the first one performed in Kolkata in 2018. The future holds promise for more donors and better outcomes through new technologies and understanding of rejection.

Uploaded by

Juhi Neogi
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOCX, PDF, TXT or read online on Scribd
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A CHANGE OF HEART: THE TRYST BETWEEN INDIAN SURGEONS

AND HEART TRANSPLANTS


JUHI NEOGI, 9TH SEMESTER, KPCMC&H

Since Dr Panangipalli Venugopal’s first groundbreaking, successful heart transplant in 1994, the
count has crossed 350 in India. [Dr Venugopal is also accredited for performing, for the first time
in Asia, implantation of a Left Ventricular Assist Device (LVAD)].

A heart transplant, or a cardiac transplant, is a surgical transplant procedure performed on


patients with end-stage heart failure or severe coronary artery disease when other medical or
surgical interventions have failed. As of 2018, the most commonly performed procedure is to
take a functioning heart, with or without transplanting one or both lungs at the same time, from a
recently deceased organ donor (brain death is the standard) and implanting it into the patient. The
patient's own heart is either removed or replaced with the donor heart (orthotopic procedure) or,
much less commonly, the recipient's diseased heart is left in place to support the donor heart
(heterotopic, or "piggyback", transplant procedure).

The Surgical Procedure:

The surgeon will ensure that the donor heart is viable before beginning the transplant surgery. The
transplant surgery will take place as soon as possible after the donor heart becomes available.

During a heart transplant, the patient is placed on a heart-lung machine to maintain circulation.
Surgeons then remove the patient's heart except for the posterior walls of the atria. The posterior wall
of the atria on the new heart is opened and the heart is sutured into place. The great arteries and veins
are then connected to the new heart. As the heart warms up, it begins beating. Surgeons check all the
connected blood vessels and heart chambers for leaks before removing the patient from the heart-
lung machine. The surgery may take 4-10 hours.

The patient is made ambulatory a few days after surgery. Unless the patient show signs of early
rejection, he is discharged between 7-16 days. Although the most common cause of mortality are
infection and rejection, the immunosuppressive therapy protecting the heart puts the patient at risk
for developing kidney failure, osteoporosis, hypertension and lymphoma. Atherosclerosis of
coronary arteries has been documented in half of patients who didn’t complain of angina as they did
not have sensation in their new hearts.
The First Heart Transplant in the World:

Groote Schuur Hospital was placed centre stage in the world's spotlight when Professor
Christian Neethling Barnard performed the first human heart transplant on December 3, 1967.
His teacher,  Professor Wagensteen, a pioneer in experimental surgery, perfected the heart lung
machine. Mr. Louis Washkansky was a diabetic, and had an incurable heart disease, causing him
to suffer three heart attacks. The last of these heart attacks led to congestive heart failure. He
underwent cardiac catheterization, but only had about 30% cardiac function. Heart transplant was
his only hope. Washkansky received his heart transplant on 3 December 1967, at the Groote
Schuur Hospital in Cape Town, South Africa. The operation lasted 6 hours with Dr.
Barnard leading a team of thirty surgeons, anaesthetists, nurses and technicians. The donor was
25-year-old Denise Darvall, who suffered from a traumatic brain hemorrhage the same day.
Sadly, Washkansky only lived for 18 days, succumbing in the end to pneumonia. His new heart
beat strongly to the end.

Professor Christian Barnard with Louis


Washkansky

Heart transplants in India, 52 years later: The discovery of immunosuppressive drug therapy is
the medical breakthrough which improved the success rates of organ transplant surgeries. More
recently, Ventricular Assist Devices (VADs), implantable mechanical heart pumps, have been
used to buy more time for patients who need heart transplants while they wait for a donor’s heart.

First Heart Transplant in Kolkata : On May 21,2018, the city witnessed its first heart
transplant. The donor heart was flown in from Bangalore in a chartered flight to Fortis Hospital,
Anandapur. The recipient was 39-year-old Dilchand Singh suffering from severe irreversible
diabetic cardiomyopathy. The surgery was conducted by Dr KM Mandana and Dr Tapas
Raychaudhury, both renowned Cardio-Thoracic surgeons. Two years ago, Rupayan Roy became
the first heart transplant recipient from Kolkata. He underwent a heart transplant at Fortis Malar
in Chennai in July 31, 2016, for dilated cardiomyopathy.

Future of Heart Transplants: Heart transplantation has now entered an era of tremendous
growth and innovation. Much of this progress in heart transplant medicine is predicated on a
better understanding of acute and chronic rejection mechanisms through basic science studies.
The future will also include personalized medicine where genomics and molecular science will
dictate customized treatment for optimal outcomes, thus alleviating the desperate need for
cardiac transplantation.
The introduction of mechanical circulatory support (MCS) devices has changed the landscape for
patients with severe heart failure to stabilize the most ill patient and make them better candidates
for heart transplant. As ex vivo preservation takes hold, we may witness an expansion of the
donor pool through the use of donation after cardiac death (DCD) donors. In addition, further
geographical donor heart sharing through ex vivo preservation may further decrease waitlist
mortality by enabling longer distance donor hearts to be allocated for the most moribund waitlist
patient.

To conclude, heart transplantation surgery has given a second lease of life to patients of end
stage heart diseases, worldwide. Indian surgeons have embarked upon a mission to ensure
quality life by various surgical innovations in the past 2 decades. From robotic surgery to heart
transplantation, medicine has come long way in providing patient centric care more that disease
oriented care. The collaboration between the public and private sector is propitious. We may
hope to imbibe the potential breakthroughs in all disciplines of medicine to provide equitable yet
efficient evidence based patient care.

[Source: Annals of Cardiothoracic Surgery, National Institutes of Health, USA]

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