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Heart Transplantation at Apollo Hospitals Chennai

The Apollo Hospitals performed the first heart transplantation in 1995. This patient went on to survive for 14 years (the longest Indian transplant survivor) until 2009 when he succumbed to an unrelated cause.

In 2004, a multidisciplinary approach to End Stage Heart Failure was envisaged and a formal Heart Transplant Programme commenced in Apollo Hospitals. Apollo Hospitals has successfully performed over 32 Heart transplants, 25 Lung transplants, 7 Heart and Double Lung transplants and 1 Heart Lung and Kidney transplantation.

Donor awareness has increased in the recent years and the State of Tamil Nadu has one of best Government led Cadaver Programmes in India.

Milestones

  • The Department of Heart and Lung Transplantation, Apollo Hospitals has performed over 64 transplantations. The team has performed 35 Heart transplants, 29 Lung transplants, 11 combined heart and lung transplant and 2 Double Lung transplants, 3 Single lung transplant with results on par with International standards. We have the foremost donor resuscitation and assessment program in the country that has lead to our outcomes (Long term survival Heart - 87%
 Lungs - 67% (Primary pulmonary hypertension -75%, Interstitial lung disease -60%).
  • Achieved the best outcomes in Heart transplant with an 87% long term success rate.
  • Largest number of lungs transplanted in a single unit in India.
  • The oldest male (67 yrs) and female (63 yrs) in India underwent successful Heart transplantations at Apollo Hospitals.
  • The first ever Bridge to Heart (BTH) transplant (LVAD to Heart transplant) to be performed in India was done in Apollo Hospitals.
  • The team has performed the first successful emergency heart transplant in the country.
  • Apollo Hospitals performed the first OCT in the country (Optical Coherence Tomogram) for assessment of chronic rejection in a patient who is over 4 years post transplant. This technique is just evolving in the west.
  • Apollo Hospitals performed Single Lung transplant on the oldest person.
  • Apollo Hospitals performed India’s first Double Lung transplant for Hermansky- Pudlak syndrome (2nd in world).
  • Apollo Hospitals performed India's first Heart Lung and Kidney transplant (2nd in world).
  • Apollo Hospitals performed the largest ECMO series in the country for acute lung failure.
  • Apollo Hospitals performed the first heart transplantation in 1995. This patient went on to survive for 14 years (the longest Indian transplant survivor).
  • The largest experience with endomyocardial biopsy for transplant surveillance in the country.
  • In addition ISHLT (the International Society for Heart and lung transplant) based in the US has admitted us (as the first unit in India) to participate in their registry. This will not just ensure the international scrutiny and transparency of our program, but will also in their annual meeting showcase our outcomes against all International centres. This automatically ensures that we have to perform to the highest standards in this particularly demanding field.

Multidisciplinary Heart Transplant Team:

At our Hospital in Chennai, we have a dedicated Heart Transplant team comprising of the following:

  • Transplant Surgeons
  • Transplant Cardiologist
  • Intensivists /Critical Care Specialist
  • Pulmonologist
  • Infectious Disease Consultant
  • Immunologist
  • Pathologist
  • Transplant Co-ordinator
  • Trained ICU & Ward Nurses
  • Liaison officer

Government of Tamil Nadu Transplant Recipient Waiting List:

There is a Waiting List maintained by the Government of Tamil Nadu for recipients awaiting Solid Organ Transplantation and when we have a suitable patient he is added on to the waiting list and is offered the organ strictly on waitlist priority basis.

Pre Heart Transplant Work up:

In addition to complete the clinical examination and review of all investigations, specific to Heart Transplantation, we have an Interdisciplinary team consisting of specialists in Cardiology, ID, Nephrology, Pulmonary, Critical Care, Endocrinology, Cardiac surgery and an Anaesthetist., below are a comprehensive set of pre-operative investigations that are performed.

  • An ICU based right heart catheter - to estimate reversibility or irreversibility of pulmonary pressure, manipulation of pulmonary pressure with a variety of drugs and assessment over 24 hours before listing for transplant.
  • Use of myocardial PET to rule out possibility of viability quite a few patients have undergone high risk CABG with excellent outcomes as a result instead of blindly listing for transplant.
  • A full immunological work up quantitative PRA and full tissue typing.
  • An exhaustive infectious diseases screen to minimize infections post transplant.
  • Renal tests including measured GFR and FeNa to quantify the severity of cardio-renal syndrome.
  • Full endocrine profile.

We risk score the patient to predict 1 year outcomes without transplant and list only when the benefits of transplant clearly exceeds the risk.

In the acute heart failure setting, we have a focused ICU management of these critically ill patient, we have access to ECMO, LVAD and have successfully done emergency heart transplant when a donor has been available.

Post-Operative Care:

We have dedicated beds for patients who have undergone heart transplantation in our well-equipped Cardiothoracic ICU. Barrier Nursing is instituted to avoid infective complications.

Who will benefit from the evaluation?

Heart - when conventional treatment options have been ruled out:

  • Anyone with an EF < 35% in NYHA 2-3
  • Anyone with NYHA 4 symptoms
  • Massive MI with CHF post stent or CABG
  • CHF post Valve Surgery
  • Recurrent Angina ineligible for PCI or CABG
  • Malignant Arrhytmias - on AICD (too many shocks, poor quality of life)

Lung Transplants:

We have the most experience in India with lung transplants. We have evolved a program of intense evaluation of donors especially with respect to latent TB which is a very important problem in our country.

Who will benefit from the evaluation?

Lung end stage lung disease (COPD,ILD, Bronchiectasis, CF, primary and secondary irreversible pulmonary hypertension:

  • Unable to complete a 6 min walk test, or less than 300 m covered, or desaturation (< 88%)
  • Breathless at rest or requiring oxygen
  • Increasing Pulmonary Hypertension on Pulmonary Vasodilators
  • RV dysfunction on RV echo

Lung transplants have been done over last 2 years and heart transplants since 2008.