In a first-of-its-kind in India, where Impella mechanical circulatory support was given as bridge to heart transplant in an adult.
The individual had a medical history of diabetes, hypertension, massive anterior wall myocardial infarction, ventricular tachycardia (abnormal heart rhythm), and cardiogenic shock.
Kauvery Hospital Chennai, a unit of Kauvery Group of Hospitals, a leading multispecialty healthcare chain in Tamil Nadu, successfully performed a heart transplant for a 63-year-old with cardiogenic shock and a complex medical history. In a first-of-its-kind approach in India, the man was given Impella percutaneous left ventricular assist device (pVAD), to support his heart until he received a heart transplant. Impella, also known as the world’s smallest percutaneous heart pump aids a failing heart in pumping blood from the ventricles to the rest of the body while allowing the heart to rest and recover.
The 63-year-old man had a sudden onset of breathlessness and was admitted to a local hospital two weeks after an episode of severe chest pain, where he was managed for low blood pressure. During the same time, he had episodes of Ventricular Tachycardia (an abnormally fast heart rate that eventually leads to cardiac arrest), and he was revived through electrical shocks. He was then given multiple medications to improve the pumping function of the heart, despite which he was rapidly deteriorating and was on the verge of losing his life. He was shifted to Kauvery Hospital as an emergency for further treatment.
“We immediately moved him to the hybrid cath lab with consent of the family for an emergency angiogram and further treatment. His left anterior descending artery was totally blocked, leading to total irreversible damage, thinning of his left ventricle and extremely poor heart function. At this stage, his expected survival rate was less than 10%. As we have a ‘Heart Recovery’ program, we were able to implant an Impella device immediately to save him and prevent damage to other organs of the body including brain, liver and kidneys. Without the ‘Heart Recovery’ program, it may take upto 24 to 48 hours for the company to arrange Impella. The Impella pVAD support system removes blood from left ventricle and pumps to rest of the body, thereby allowing the left ventricle to rest and recover, while other organ functions are preserved. This temporary mechanical cardiovascular support system can sustain a patient’s heart for up to seven days or longer. He was intubated in the critical care unit for pulmonary edema and low BP, and the Impella worked well,” says Dr R. Anantharaman, Senior Interventional Cardiologist and Lead for Circulatory Support at Kauvery Hospital.
”Due to reduced pumping capacity of heart, kidneys were initially affected. Once the Impella was given, the urinary output improved and his heart failure symptoms, respiratory functions improved, allowing us to remove him from ventilatory support. However, the heart function did not improve due to recent massive heart attack he had 2 weeks prior to admission, and he was dependent on the Impella support for survival. He was assessed by the Heart and Lung Transplant team at Kauvery Hospital and advised heart transplant or a permanent Left Ventricular Assist Device (LVAD) as a bridge to transplant if there was no donor heart available in time. He was put on the transplant waiting list, and was preparing for LHVAD simultaneously. He remained stable on Impella and was scheduled for elective LVAD by day 8. However, he received donor heart the day prior to LVAD implantation. The transplant surgery was performed under the Heart and Lung transplant team led by Dr Kumud Dhital, along with Cardiologists, Cardiothoracic Anesthetists and Transplant Critical care team support. He has returned home after two weeks, and is now doing fine,” added Dr Anantharaman.
Dr Aravindan Selvaraj Co-Founder and Executive Director of Kauvery Hospital Chennai, said, “This particular scenario was very challenging as the individual had a complicated medical history and his heart was weakened by the time he reached our hospital. We have used Impella and successfully sustained the heart before the transplant. This was possible due the world class infrastructure and the expertise of the dedicated Heart Recovery program / Heart & Lung Transplant program team available at Kauvery Hospital. Also, Kauvery Hospital is one of the very few centers to facilitate the in-house Impella Implantation. The Hybrid Cath Lab which is well equipped helps in performing highly complex procedures and surgeries in the same room without having to shift the patient and it is also the safest place to perform complex procedures. The best expertise combined with world class infrastructure makes it possible to save lives. I congratulate Dr Kumud Dhital – Head of Heart and Lung Transplant Unit, Dr Ananthraman, Senior Interventional Cardiologist and Dr Srinivas Rajagopala- Director Transplant Pulmonology and Lung Failure Unit and the entire team for giving a second life to the 63-year-old gentleman.”
