The Apollo Hospitals story started with the heart. The Apollo Heart Institutes pioneered open-heart surgeries and cardiac catheterization in India. The flagship hospital, Apollo Hospitals, Greams Road, Chennai, is one of the pioneers of cutting-edge Heart Care in India. Today, it is also an unparalleled leader in Cardiology and cardiothoracic surgery with the sole intention of providing world-class and superior-quality Cardiovascular care to patients visiting the hospital from across the globe.
The dedication of our Cardiologists and Cardiothoracic surgeons towards the prevention and treatment of heart diseases has gradually led us to the path of better outcomes and improved quality of life for thousands of patients visiting us each year - thus, making this hospital the most desirable hospital in India for Bypass surgery and child heart surgery.
Heart transplant surgery is a complex and intricate procedure that involves the replacement of a patient's damaged or diseased heart with a healthy heart from a donor. The surgical team responsible for performing this life-saving procedure at Apollo Hospitals comprises a group of highly skilled and experienced medical professionals who are dedicated to providing the best possible care to their patients.
The surgical team consists of five specialists supported by a team of...
Know MoreLung transplant surgery is a complex and highly specialized procedure that requires a team of highly skilled healthcare professionals to perform successfully. The team at Apollo Hospitals is renowned for their expertise in this field and is dedicated to providing exceptional care to patients undergoing this life-changing surgery.
The surgical team for lung transplants at Apollo Hospitals comprises a...
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Patients may present late, with one organ failure resulting in multi-organ dysfunction. For example, if heart or lung failure was the primary problem, they may present with liver or renal failure later. These are, by definition, complicated conditions and have to be evaluated thoroughly. However, a small proportion of these patients with multi-organ dysfunction can be treated with multi-organ transplants, provided certain parameters are fulfilled. This will definitely take a detailed evaluation with our interdisciplinary team and other transplant teams in the hospital.
Know MoreWhen a patient is in their advanced heart failure stage, they may require to have their heart or lungs supported by machines, or sometimes both heart and lungs supported by machines. The machines could be a temporary or permanent measure.
Some patients require temporary support to help them during their recovery or to assess their prognosis for definitive treatment. Short-term Mechanical Circulatory System devices provide crucial assistance during high-risk procedures or while the patient's condition stabilizes...
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At our hospital, we provide long-term support for patients with congestive heart failure using different types of devices. There are two main types of devices used: para-corporeal and totally implantable. Para-corporeal devices are either...
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There are surgical and interventional cardiology options for patients with heart failure, provided there are reversible causes, such as coronary artery disease or valvular pathology in these patients. High-risk valve surgery, TAVR with assistance from circulatory support such as ECMO, high-risk coronary bypass surgery, or PCI can all be alternatives to heart transplantation. In addition, patients who are not eligible for heart transplantation, or require support while awaiting the heart transplant, can use ventricular assist devices as a bridge to heart transplant or as a permanent therapy for heart failure.
In general, patients who have end-stage lung failure from idiopathic pulmonary fibrosis do not have any alternatives other than lung transplantation. However, should their condition deteriorate, and they end up in intensive care while they await a lung transplant, the use of ECMO as a bridge to lung transplantation is possible. In patients suffering from severe emphysema, provided the disorder is largely localized to some part of the lung and not the whole lung, lung volume reduction surgery may be helpful to avoid or delay the transplant.
In some patients who have multi-organ dysfunction, such as heart with lungs or heart with liver or heart, lungs, liver or kidney, some select patients can have multi-organ transplantation. Our unit is among the pioneers in multi-organ transplantation as we work very closely with the liver and renal transplant teams.
Patients who are diagnosed with heart failure may not always need a heart transplant. In fact, it is a treatment for a minority of patients with heart failure. There has been an advent of many new medicines that can control the failing heart effectively and provide a high quality of life for many years without the need for a transplant. Conversely, not all patients with heart failure will be eligible for a heart transplant.
There are many groups of medicines that help avoid a transplant. For example, medicines that increase your urine output so that the amount of fluid collection in your body is reduced, medicines that reduce the blood pressure so that the heart does not have to work so hard, and there are newer groups of medicines that parallel the outcomes of a heart transplant and hence can be used to avoid a transplant. You can check with your doctor to see if you are eligible for these medications and if you are on the correct dosage.
Heart failure could be a result of poor blood flow to the heart, such as in coronary artery disease, or due to valve dysfunction. Operation on the valves or coronary bypass, or even stents, albeit at higher risk than normal, will help avoid heart transplant in select sets of patients. In some patients who are not eligible for a heart transplant, a left-ventricular assist device can be placed as a permanent solution to heart failure. Sometimes, correction of abnormal electrical activity may also help.
There will be dietary restrictions on patients with heart failure, largely to reduce the amount of salts or the fluid that the body retains in heart failure. But by and large, a low-calorie balanced diet, which is also a bit low on carbohydrates, will help patients provided there are no additional organ dysfunctions such as kidneys or liver. This is something that your doctor, along with a dietician, can chart out on an individual basis.
A heart transplant, when the patient is properly assessed and has been rehabilitated both physically and nutritionally prior to the transplant, carries a risk of about 8 to 10% at one year. Hence it is considered a low to moderate-risk surgery in the majority of patients. Patients who have multi-organ dysfunction and are in ICU with a significant amount of support do have a higher chance of dying while they undergo a heart transplant from an ICU. The risk vs. benefit to the individual patient can be done quite objectively by clinical examination, investigations as well as risk stratification. Heart transplant will be considered only when the risk of the transplantation is lesser than the risk without the transplantation. Your doctor can advise you more on the above.
In an uncomplicated heart transplant, the patient is usually discharged within five to seven days, by which time the patient will be fully mobile and walk at least one flight of stairs. Further nutritional and physical rehabilitation will continue at home for a period of four to six weeks. Some restrictions do apply, such as avoidance of areas with a high risk of infection, and dietary restrictions, such as avoiding uncooked or raw vegetables, will apply for at least one year in view of the patient being immuno-suppressed. Otherwise, patients can have a normal to near-normal life, including returning to work after a heart transplant. There are instances of patients even taking part in physically demanding sports after heart transplant.
There are many different causes for lung failure, and lung failure can itself fall into different grades of severity, such as mild, moderate, or severe, and the causes themselves would be reversible or irreversible. The lung transplant should only be contemplated when the team has ascertained for certain that the cause for lung failure is irreversible and the lung itself is in severe organ dysfunction.
Lung failure is a broad term that encompasses different diseases whose final common pathway leads to the destruction of the lungs. The main stake for patients who have lung diseases is medicines and, in some cases, for example, in interstitial lung diseases, the usual treatment involves steroids. Some of the other conditions, such as PPH, TB, bronchiectasis, and chronic hypersensitivity pneumonitis that could be caused, among other things, by birds, for example, pigeons, have to be properly tested, identified and treated before considering a lung transplant. In addition, a variety of supportive measures can also be undertaken to help reduce the symptoms of end-stage lung failure.
In a condition called Chronic Obstructive Airway Disease, otherwise called emphysema, in certain subgroups of patients, lung volume reduction surgery can help to avoid or delay a lung transplant.
Although patients with end-stage lung failure will find it difficult to move around because of lack of oxygen and also the build-up of carbon dioxide, during the assessment of lung transplant, we can objectively decide how much exercise is possible, and the patients are usually encouraged to continue to improve their muscle mass as well as their exercise capacity as this helps both in reducing the symptoms while they await lung transplant and also improves outcomes. This is completely possible if done under supervision.
There are many reasons why breathlessness may be getting worse.
In general, since oxygen is required to metabolize your food, heavy meals can actually exacerbate breathlessness and other symptoms of lung failure. A diet that is designed specifically for you, which gives adequate energy but does not stress the gastrointestinal system too much, is necessary to help keep the symptoms under control while also ensuring that the patient does not get malnourished.
This is something that requires detailed assessment and analysis. But by and large, if you do get breathless or desaturate, it is better to use oxygen, as a lack of oxygen leads to more stress on the right ventricle of the heart. In order to avoid extra stress on the right ventricle, it is preferable to use oxygen as much as possible.
Long Covid has a constellation of symptoms, including breathlessness. It can also be because the lungs have not fully healed. Not all patients with long Covid and breathlessness require a lung transplant unless the breathlessness is excessive, and it has been documented that the lung has undergone irreversible scarring, i.e., fibrosis. A transplant will usually not be indicated in all patients with long Covid.
In general, lung cancers are not indications for lung transplant. However, there are special types of lung cancers in some patients who can benefit from lung transplantation. You will need a full consultation with both the transplant as well as the oncology specialists before the decision is taken.
The lung is a sensitive organ that is continually exposed to the environment. As it interacts with the environment, it is exposed to a variety of toxins and bacteria, and viruses, and this can lead to rejection episodes as well as infections. Hence, for the first three months, a fair amount of restriction and seclusion will be required. However, the patient will be able to mobilize fully and will most likely be completely off oxygen over the next six months. If further tests reveal that there is no infection or rejection, by the end of the ninth to the twelfth month, the patient should have a completely normal life, albeit with some restrictions, so that they do not over-expose themselves to infections.
Infection and rejection are the two major problems after a lung transplant. But a person after the transplant has an expected survival of 80 to 85% one year after surgery and about 50 to 60% five years after surgery and about 30 to 35% ten years after surgery. One has to remember that this is for a group of patients who have predicted mortality of more than fifty to seventy percent one year after diagnosis without a lung transplant.
Proper assessment is needed. If the other organs are reversibly affected, then medicines can help. However, if they are also irreversibly damaged, then consideration will be given to multi-organ transplantation.
