Despite the challenges posed during these COVID-19 times, MGM Healthcare, a multi-specialty quaternary care hospital in the heart of the city, became the third hospital in the world to announce the successful completion of a critical bilaterallung transplant on a COVID-19 positive patient. This is Asia’s first known lung transplant on a COVID-19 positive patient and the second lung transplant in the hospital since the lockdown began. The transplant was led by Dr. K. R. Balakrishnan, Chairman & Director of Cardiac Sciences and Director of the Heart and Lung Transplant Program at MGM Healthcare, and his team of transplant specialists including Dr. Suresh Rao, Dr. Srinath and Dr Apar Jindal.

The transplant was performed on a 48 year oldgentleman from Delhi, who was suffering from severe lung infection with COVID-19. His lungs were severely damaged due to COVID-19 related fibrosis. He developed COVID infection on 8^th June 2020.  Only a small portion of the lungs was still functioning. As he became breathless and oxygen saturation came down he was put on ventilatory support on 20^th June 2020.  His condition continued to be worsening inspite of ventilator support, he was airlifted to MGM Healthcare from Ghaziabad on 20^th July 2020.  His lung condition continued to be worsening in spite of maximum ventilatory supportive care, and he was put on ECMO support on 25^th July 2020 for more than one month. Such patients are difficult to manage even in well-equipped ICUs.

Commenting on the procedure, Dr. K. R. Balakrishnan said, “We were initially in a dilemma when his case was referred to us. But as doctors, we are taught to prioritise the patient’s overall health over anything else. Keeping this in mind, we decided to proceed with the surgery. Here I would like to commend and thank my team of doctors and the other support staff for taking up the challenge and boldly standing by the decision to go ahead with the transplant, without thinking about the risk to their own health and safety. We are happy for the patient as the transplanted lungs are working well.”

According to Dr. Suresh Rao, Co-Director, Institute of Heart & Lung Transplant and Mechanical Circulatory Support, “as the patient’s both transplanted lungs were working well, we removed the ECMO support.  Now his clinical condition is stable.  At the same time, we accepted the heart from the same donor to another patient who was waiting for a heart transplant, thereby giving a new lease of life to two people”.

Commenting on the patient’s condition, Dr. Apar Jindal, Clinical Director & Consultant, Lung Transplant, Interventional Pulmonology & Chest Medicine said, “Those select patients suffering from COVID pneumonia where all medications and mechanical ventilators fail to show positive results, an early initiation of ECMO support may be a lifesaving modality.  Over time, progression can determine whether the patient improves spontaneously or may be offered the option of lung transplant.  Lung transplant may well be the answer to many of the COVID survivors whose lungs are healing with fibrosis and making them a chronic respiratory cripple.”

“While the lockdown and the phased unlocks are a much-needed moves to limit the community’s chance of exposure to the Coronavirus, MGM believes that health caring must go on. The good news from a healthcare perspective is that despite the travel restrictions imposed by the Government, both at the centre and State levels, medical contingency travel was never a problem if a patient and close family members followed the procedures laid down. It’s indeed a proud moment for MGM Healthcare…the long distance travel that the patient and his family decided to undertake despite the limitations is testimony to our expertise when it comes to transplants. I would also like to take this opportunity to thank everyone who played a role in ensuring that hereached us at the earliest for the next treatment steps to be expedited,” adds Dr. Prashanth Rajagopalan, Director, MGM Healthcare.

The transplant was performed on August 27, 2020. Post the transplant, the patient is doing fine in the Transplant ICU at MGM Healthcare.

Also read : LUNG TRANSPLANT- A RAY OF HOPE

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Chennai:  MGM Healthcare has performed a complex artificial heart implant procedure for the first time in South East Asia, Middle East& Africa involving two artificial heart pumps known as ‘Berlin Heart’ to support both the right and left side of the heart of a 3-year old Russian boy,weighing 10 kg. The procedure was performed on 25^th May by a team led by Dr K.R. Balakrishnan,Chairman & Director of Cardiac Sciences and Director of the Heart and Lung Transplant & Mechanical Circulatory Support Program at MGM Healthcare.

The first of its kind, Berlin Heart Implantation was performed over a 7-hour long marathon surgery in collaboration with engineering support teams from UK and Germany guided by state-of-the-art virtual technology due to travel restrictions imposed by the COVID-19 crisis. Baby Lev Fedorenko suffered from a heart condition called restrictive cardiomyopathy wherein the walls of the lower chambers of the heart, called the ventricles, are too rigid to expand and receive any blood.

The parents of the baby flew him down to Chennai to consult with Dr K R Balakrishnan and seek possible solutions for their child’s medical condition. He was initially managed with medications for around two months, but unfortunately his condition started worsening, and he became critically unwell and required hospitalization at MGM Healthcare. He continued to deteriorate and had two episodes of cardiac arrest, where the heart stopped beating and had to be resuscitated with manual compressions for several minutes. The only option possible for such a small child was an artificial heart pump and since both the right and left side of his heart were affected, he needed two heart pumps. Small pumps for such a small child known as Paediatric Biventricular pump are made only in Germany by a company called “Berlin Heart”.

Implantation of the “Berlin Heart” in a little child was always going to be a mammoth task. It was a challenge to fit the cannula needed for the pump inside the small chest cavity of this child. The surgery was also complicated by the fact that it was performed amidst a period of complete lockdown in the city of Chennai, at the height of COVID 19 pandemic. Additionally, managing anesthesia and surgery in such a small child wearing the mandatory personal protection equipment warranted the best of clinical expertise. Experts from multiple backgrounds and countries joined via tele-conference to support the team in Chennai, notwithstanding the physical barriers imposed by COVID-19.

This complex surgical biventricular heart implantation is the first such implant in South Asia, South East Asia and among the few in the whole of Asia stretching from the Middle East to Far East. This is also the first recorded time in the world, that this complex procedure has been done with complete virtual support. Commenting on the treatment, Dr. K. R. Balakrishnan said,“this was a huge challenge, given the prevailing circumstances. Berlin Heart will support the circulation of this child till the heart recovers or he gets a transplant. Post implant, Lev Fedorenkowas kept under observation for a few weeks. The child has recovered remarkably well and has gained weight in a very short time and has been discharged from the ICU. He is doing absolutely fine now,” added Dr. Balakrishnan.

Speaking on Berlin Heart procedure Co-Director – Institute of Heart and Lung Transplant & Mechanical Circulatory Support and HOD – Cardiac Anaesthesia, Dr Suresh Rao said “Newborns with heart failure or children suffering from severe heart insufficiency don’t really have much of a choice. A heart transplant most of the time is the only survival possibility.   The problem the doctors are facing, is that there is hardly a chance to keep their patient’s condition stable until heart transplant becomes possible. Waiting times are much too long until donor hearts become available. The demand for life-saving heart assist devices, which could bridge the time by mechanically supporting the heart function, is enormous.”

The Berlin Heart VAD consists of a plastic pump or chamber which is outside of the body. It has a blood-filled side and an air-filled side, separated by a flexible membrane. The blood-filled side of the pump is connected directly to the child’s own heart and main artery by means of two tubes or ‘cannulae’. The air-filled side of the pump is connected via a long plastic tube or ‘driveline’ to a driving unit.The driving unit of a Berlin Heart drives air into and out of the heart pump(s). As air is pulled out of the pump, the membrane separating the two sides of the pump is drawn back, pulling blood into the pump from the main pumping chamber of the child’s own heart.

Berlin Heart GmbH is the only company worldwide which develops, manufactures and distributes both implantable ventricular assist devices for patients with heart diseases. The systems INCOR^®, EXCOR^® Adult and EXCOR^® Pediatric support short- to long-term pumping function of the heart and thus present a life-saving therapy possibility for the patient. MGM Healthcare is the only hospital in South East Asia, Middle East & Africa to use this device to perform a lifesaving surgery. Other members of the team that performed the procedure, included  cardiac surgeons Dr V.Srinath and Dr S. Ganapathy, Senior Consultants, MGM Healthcare. The team has performed the largest number of mechanical circulatory device implantation for heart failure management in India.

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