Department of Heart Transplantation
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 all other medical or surgical treatments have failed.
The most common procedure is to take a functioning heart, with or without both lungs, 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 and replaced with the donor heart (orthotopic procedure) or, much less commonly, the recipient's diseased heart is left in place to support the donor's heart (heterotopic, or "piggyback", transplant procedure).
Heart transplantation is not considered to be a cure for heart disease; rather it is a life-saving treatment intended to improve the quality and duration of life for a recipient. Since the performance of the first human heart transplant in 1967, heart transplantation has changed from an experimental operation to an established treatment for advanced heart disease. People who have advanced (end-stage) heart failure, but are otherwise healthy, may be considered for a heart transplant.
Continental Hospitals have state-of-the-art infrastructure to support the function and have attracted some of the best intellect and expertise from this field. They all follow the philosophy of excellence and empathy and give their whole in seeing the patient back home with a new heart. The round-the-clock paramedical and support staff is very caring and concerned and intertwines with the patient's family to educate and train them and support them emotionally, whenever required.
Continental Institute of Cardiovascular Sciences is a specialized and one of the best cardiology hospitals in Hyderabad committed to preventing, improving and repairing heart and vascular health.
Through a comprehensively designed program consisting of contemporary medical invasive and non-invasive procedures, state of the art operation theatres equipped with the latest technology and robust diagnostic support, we offer the entire realm of heart care- from diagnosis to rehabilitation.
With a high focus on a compassionate and secure doctor-patient relationship, Continental Hospitals has set a benchmark for high-quality medical care and is among the best heart hospitals in Hyderabad.
Facilities at Continental for Heart Care are by far the best and include:
- Cardiac Preventive & Nutrition Centre
- Advanced Heart Failure Centre
- Arrhythmia Centre
- Cardiac Catheterization Lab
- Comprehensive Cardiovascular & Thoracic Surgery Services
- Electrophysiology Lab with 3D Cardiac Mapping & Radio Ablation System
- Echocardiography (2D & 3D) Lab
- Echocardiography (2D & 3D) Lab
Diagnosis for heart and lung transplant is not a matter of a few tests and is not spread out over just a few days or weeks. It is an ongoing process as the condition of the patient’s heart is monitored. It is also a multi-disciplinary one as it involves other specialists who can vouch for the performance of their respective systems in the patient’s body and give the green signal for the surgery. Also, a transplant is performed only if all other means of treatment have failed or do not yield any results. Once it has been decided to go ahead with the transplant, a battery of tests awaits the patient. Also, the severity of the patient’s condition determines the priority on the waitlist.
What are the different technological advancements in heart transplants?
Mechanical circulatory support devices can be used to restore blood supply and prevent heart failure or eliminate the need for a heart transplant.
- LVAD is a device called the left ventricular assist device, used for patients with an end-stage heart failure that weakens the function of the left ventricle in pumping blood to the rest of the body. The device is battery operated and is surgically implanted into the body.
- RVAD is a device called the right ventricular assist device, used for patients with an end-stage heart failure that weakens the function of the right ventricle in pumping blood to the lungs. The device is battery operated and surgically implanted into the body.
- BiVAD is a device called the bi-ventricular assist device, used for patients with an end-stage heart failure that weakens the function of both the right and the left ventricle in pumping blood. It is a battery-operated device that is surgically implanted into the body and it restores continuous blood supply within the body.
The heart transplant treatment includes the entire process after diagnosis, which we have explained in its entirety below.
A transplant is required only if any of the heart valves, heart muscles or lung tissue have been permanently and irreversibly damaged. There are two bases of evaluation of the patient's condition. By the first, we assess if there are any conventional methods of treating the disease and only upon exhaustion of those do we consider transplant as an option. By the second we evaluate if a transplant will make any difference at all to the patient and his life afterward. The former is an ongoing process involving your physician and cardiologist. The patient is evaluated for the fitness of other supporting organ systems, any other medical conditions, infections that may disqualify the patient from receiving an organ and the ability of the patient and the family to go through the grind. After the transplant, there is a lot of dedication expected from the patient’s side. The transplant can be successful only if the patient is willing to follow a fixed diet, remain on medication throughout, be regimented about exercise, and do the regular follow-ups. An informative educational session is always given to the patient and the family, explaining all aspects of the treatment. We at Continental patiently explain the entire process and educate the patient and the family about all its aspects. Therefore, Continental Hospitals is the best place for the treatment of heart failure.
The wait time for a heart or lung in the case of a transplant is not in the control of the surgeon but ranges between 2 to 6 months. The patients are ordered not only according to the time at which they join the queue but also based on their condition. Some patients are classified as Status 1 patients, meaning they have to be prioritized over others. The diagnostic tests are also routine ones, excepting one or two that may require the patient to get admitted for a day or so.
A heart transplant is a proven safe method. The first transplant was done in 967 by Dr. David Bernhardt in Africa and since then over 100,000 transplants have been done. About 4000 transplants are done annually across the world, 50 of them in India. The number is small since there are only a few facilities in the country equipped to do this procedure. Continental Hospitals is one of the best hospitals for heart transplant surgery in Hyderabad.
Resuming life as before
A patient can resume work after 3 to 6 months of the transplant. This is to make sure the new organ has been accepted and to guard nascent organs against infections. Driving can be resumed after 2 to 3 months since that the time is taken to heal the breastbone. If not healed, chances of irreversible damage are high in case of an accident. Visiting a dentist is the scariest thought from the perspective of the physician and surgeon. That is because the oral cavity is the easiest place for infections to enter the bloodstream. Dentists must be made aware of the transplant and if need be consult with the surgeon. So also, with pregnancy. Medications or the procedure have no bearing on fertility. But pregnancy must be deferred to after a year of the transplant at least. Keeping the surgeon/physician in the loop with the gynecologist is a good idea. Swimming is to be done with caution and if too many people swim in the pool it is advisable not to. International travel is fine, but keep the doctors in the loop. Certain destinations need specific vaccinations and the doctor must be sounded off before taking those. Also, always ensure that a medical center is available in the place you plan to visit.
Keep infections at bay
Basic and simple precautions can help do that. Simple things like wearing a mask in public places or while doing work at home like cooking, cleaning must be used. Stay away from others with infection or children who have just taken a vaccination. Wash hands, cut nails, wash raw produce thoroughly before consumption, use clean utensils, boil water and such others.
Dietary restrictions after transplant
Diet restrictions must very strictly be observed after transplant and it is crucial to understand why. Salt or sodium and fluid intake must be kept in check. Else this causes a lot of strain on the heart. Any salt substitutes need to be ratified by the dietician. Calorific intake must be kept within bounds as it is the main source of weight gain. Weight gain has to be ruled out at all costs since it adds pressure to the new heart. Increased weight implies increased cholesterol levels in your blood which will induce coronary artery disease in the patient’s heart.
About 95% of the patients who have undergone surgeries survive one year afterward, 90% survive for two years and so on till about 50% survive for up to 10 years! The reason for not surviving longer is usually an infection of some kind. Utmost care is taken to keep infections to a minimum and combat them fiercely even if they do creep in.
Recovery process and medication
Patients have to stay in the hospital for between 2 and 3 weeks after surgery, of which about a week or sometimes 2 may be in intensive care. Pain during this period is managed by our doctors using pain medication. Besides these many other drugs are taken. Immune suppressants that suppress the natural immune system of the patient are essential for the new organ to be accepted. They remain one of the lifelong medications to be taken. Antibiotics, antivirals, and fungicides are therefore required to keep infections at bay. To speed up the recovery process supplements of vitamins and minerals may be given. Preventive medicines like coronary artery disease-preventing ones and those to regulate blood pressure are given. Of these only 2 or 3 will remain lifelong. At no point can medications be stopped without consultation with the physician.
Sourcing the heart
The heart is sourced from dead persons and it has to be transplanted within 4 to 6 hours after that, until which time it has to be stored in a sterile container at fixed temperatures. Blood groups of donors and recipients have to match exactly in the case of adults. For children his condition is relaxed. During the exchange, the patient is kept on a heart-lung machine. The transplanted heart is made to beat while the patient is still on the machine and it is made sure that the heart is functioning properly before completing the surgery.
Continental Hospitals in Hyderabad are one of the few facilities in India that offers this comprehensive program. To do so, it has assembled a team of surgeons, transplant specialists, cardiologists, intensivists, anesthetists, heart transplant co-coordinators, nurses, care managers, physiotherapists, dietitians, and other paramedical and support staff to make it one of the frontrunners for heart transplants in India. Their heart transplant specialists are the very best in Hyderabad and the country, being extremely qualified, experienced and skilled at their trade. They stay abreast of the latest by regular training and collaboration with co-surgeons across the globe. The entire team is determined and dedicated and will accompany you on this journey to a renewed lease of life. Their involvement stays from diagnosis through surgery and the stay in the hospital and after recovery to manage your care at every stage. They educate the patient and the family about the entire process, the dos, and don'ts and share the emotional aspect of the journey. The team is supported by a robust infrastructure to handle all the varied needs of this department. Together they make Continental Hospitals the best hospital in Hyderabad for heart transplant surgery in Hyderabad.
Dr Meeraji Rao Dandangi
MBBS, MD (Gen Medicine), DM (Cardiology), FACC, FSCAI
Senior Consultant Interventional Cardiologist
Dr Pradeep Rachakonda
MBBS, MS(General Surgery), MRCS, MCH (CTVS)
Sr. Consultant Cardiothoracic Surgeon