Newer Surgical therapies for Heart Failure

Dr Hemant P Pathare is Surgical Director of HeartLung transplantation and Mechanical Circulatory device therapy in Jaslok Hospital Mumbai He is Hon Cardiac surgeon at Hinduja and Nanavati Hospitals He has participated in gt 120 Heart Transplants 69 Double lung transplants 20 permanent LVADs and countless ECMOs He performed western Indiarsquos first successful BiVAD bridge to heart transplantation Dr Pathare is Cardiothoracic Surgeon to H E Bhagat Singh Koshyari Governor of MaharashtraDr Pathare has authored the book ldquoBakhar HrudayarogacheerdquoTill date 1044 heart transplants and 138 LVADs have been implanted as in India Chronic heart failure affects more than 15 million people in our country and thus transplantation cannot be an option for allMost patients referred to Dr Pathare have had ongoing angina despite multiple stents gt 2 CABG surgeries or dilated cardiomyopathy with an expected life expectancy lt 12 months or have suffered massive heart attack with resultant cardiogenic shockA permanent VAD is a centrifugal pump titanium that is surgically implanted into the heart to augment cardiac output It is powered by rechargeable lithium batteries which are worn in a belt Total assembly weighs 1 kg A failing heart generates an inadequate cardiac output which causes buildup of fluid in the lungs with resultant severe breathlessness Poor forward flow causes loss of appetite kidney and liver dysfunction and inability to carryout routine daily activities Post VAD surgery the CO can be increased upto 10 litresmin which is more than enough to even run a marathonA centrimag device is a temporary VAD which can be used in RVAD LVAD or BiVAD configuration depending on whether patient has uni or biventricular failureOur last such patient was INTERMACS category I which has predicted worst possible outcomes worldwide says Dr Pathare This patient was brought in unconscious with HeartKidney and liver failure He underwent emergency BiVAD implantation and completely recovered in 4 weeks after which he received a new heart on the 43rd day post VAD implantation Today he is able to effortlessly cycle 5 kms dailyVADS are used as bridge to transplant if the patient is too sick to immediately undergo a heart transplant or as a bridge to decision if multiple organs have failed or as destination therapy when heart transplants are contraindicatedThe 5 years results of permanent VADs approach those of heart transplantation without the problems of immunosuppressionFor severe biventricular failure a total artificial heart can also be opted for Currently the commonest device is the SyncardiaTAH These machines are used strictly as a bridge to heart transplantation and not as destination therapyIn conclusion whilst heart transplantation remains the gold standard there are other newer options currently available that are as good as the former but also can even be used when heart transplantation is contraindicatedPhone 9820844801Email ID hpathareyahoocomWebsite wwwdrhemantpatharecom