The paradigm-shifting bloodless heart transplant
This article is authored by Dr Dhiren Shah, director, Heart Transplant Programme, Marengo CIMS Hospital.
In a ground-breaking medical procedure, Asia witnessed its first ever bloodless heart transplant. The surgery involved a 52-year-old Indian patient, Chandraprakash Garg, who was battling ischemic dilated cardiomyopathy and end-stage heart failure. The donor, a 33-year-old, tragically lost his life in a road traffic accident. This historic event marked a significant milestone in the field of cardiac transplantation.
Dr Christiaan Barnard performed the first heart transplant in Cape Town, South Africa on December 3, 1967. And the fourth surgeon to attempt a heart transplant was Dr Prafulla Sen in Mumbai, India on February 17, 1968. Heart transplantation, however, faced significant hurdles in India, mainly due to the lack of essential health care infrastructure. It wasn't until 1994 that deceased organ donation was legalised, marking the beginning of successful heart transplants in the country.
Traditional heart transplants often involve substantial blood transfusions due to the significant blood loss during surgery. These transfusions bring potential risks like endothelial damage, infection, and lung injury. Reducing blood transfusions has long been seen as a means to mitigate the risk of rejection. Marengo CIMS Hospital is, therefore, poised to become one of the top 10 global institutes to perform an absolute zero blood transfusion in a highly complex heart transplant, a life-saving procedure.
At the heart of a bloodless heart transplant lies cutting-edge technology, which played a pivotal role in real-time monitoring of blood coagulation factors. By addressing deficiencies in these factors, before surgery and managing blood thinners during the procedure, we minimised the need for blood transfusions. And besides the surgical expertise and precision, this technology causes minimal blood loss. The concept of goal-directed bleeding Management (GDBM), which has achieved remarkable success globally, in countries like Australia, the United States, and Europe holds the potential to reduce blood transfusions by up to 90%, decrease hospital stays by 70%, and cut complications such as infections and kidney damage by 70%. This not only enhances efficiency for medical professionals but also significantly improves patient outcomes.
A traditional heart transplant often amounts to two transplants for the patient—one for the organ and another for the blood. This dual transplantation carries a substantial risk of morbidity and mortality, primarily affecting the lungs and kidneys. Further, for patients whose bodies do not accept external blood transfusions, heart transplants are often impossible. In a bloodless heart transplant, the process starts from the day the patient is evaluated for transplant and continues till the post-transplant recovery phase. With the help of Artificial Intelligence, it helps to identify the probable causes of bleeding, rectify them step by step, and analyses and guides what to do next.
This groundbreaking technique, therefore, offers significant hope for these patients, potentially revolutionising heart transplantation. Remarkably, it allowed the patient to be discharged in just nine days, a stark contrast to the usual 21-24 days required for discharge, for a standard heart transplant patient. His post-surgery recovery was smoother and less complicated.
The success of the first bloodless heart transplant in Asia marks a significant advancement in cardiac surgery, offering hope to patients who were previously unable to undergo traditional heart transplants. It highlights the urgent need for innovation and progress in India, where 50,000 individuals require heart transplants annually, with only 0.2% receiving suitable donors. This achievement not only represents the power of technology and precision in modern medicine, but also allows individuals from across India to access quality surgical interventions.
As we continue to push the boundaries of cardiac surgery, the unwavering focus remains on enhancing patient outcomes, minimising complications, and ultimately saving lives. This journey has only just begun, and it holds promise for countless individuals in need of life-saving procedures.
This article is authored by Dr Dhiren Shah, director, Heart Transplant Programme, Marengo CIMS Hospital.
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