Ventricular Assist Devices (VADs) and Total Artificial Heart (TAH)
DR. HEMANT PATHARE
Dr. Hemant P. Pathare is Surgical Director of Heart-Lung transplantation and Mechanical Circulatory device therapy in Jaslok Hospital, Mumbai. He is Hon. Cardiac surgeon at Hinduja and Nanavati Hospitals. He has participated in > 120 Heart Transplants, 69 Double lung transplants, 20 permanent LVADs and countless ECMOs. He performed western India’s first successful BiVAD bridge to heart transplantation. Dr Pathare is Cardiothoracic Surgeon to H. E. Bhagat Singh Koshyari, Governor of Maharashtra.
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Dr. Pathare has authored the book “Bakhar Hrudayarogachee”.
Till 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 all.
Most patients referred to Dr. Pathare have had ongoing angina despite multiple stents, > 2 CABG surgeries or dilated cardiomyopathy with an expected life expectancy < 12 months or have suffered massive heart attack with resultant cardiogenic shock.
A 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 litres/min which is more than enough to even run a marathon.
A centrimag device is a temporary VAD which can be used in RVAD, LVAD or BiVAD configuration depending on whether patient has uni or bi-ventricular failure.
Our last such patient was INTERMACS category I (which has predicted worst possible outcomes worldwide), says Dr. Pathare. This patient was brought in unconscious with Heart,Kidney 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 daily.
VADS 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 contraindicated.
The 5 years results of permanent VADs approach those of heart transplantation without the problems of immunosuppression.
For 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 therapy.
In 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 contraindicated.
Phone: - 98208-44801
Email ID: - hpathare@yahoo.com
Website : www.drhemantpathare.com
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