An old advertising campaign for a brand of adhesives claimed that it could fix anything that’s broken, except a broken heart. Perhaps taking that as a challenge or inspiration, cardiologists around India, and the world, have tried to find solutions to end-stage heart failures - often a fatal condition.
We have some statistics. One newspaper claimed that heart attacks lead to deaths, once every 33 seconds. Other papers claimed that about 30% of adult Indians are at dire risk of heart attacks and sudden cardiac arrest or sudden cardiac deaths. One research estimated that about 10% of south Indian populations are at risk of death due to sudden cardiac arrests.
Other studies show that about 7-13% of urban Indians, and about 6% of rural Indians are at risk of Coronary Heart Diseases, and that Acute Myocardial Infarction for Indians, is seen at least 10 years earlier compared to other populations.
However you look at it, heart failure is a big national risk, and governments and institutions across the country are preparing to fight it.
At Apollo Hospitals in Chennai, Dr. M.M Yusuf - a cardiac surgeon specialising in minimally invasive surgery and heart transplantation, knows the risks and the seriousness of the issue, and is prepared to meet the challenge.
Follow Dr. MM Yusuf on Twitter Tweet to @MMYusuf_AHEL
Assisting him in this, are the latest in heart medicine, and the most modern disease management protocols.
The Last, and definitive mode of treatment.
In a few big hospitals in India, Coronary Heart Diseases are something of a daily routine. Indian cardiologists have assisted many patients over the years, performed a record number of surgeries and treatments, and have established themselves as leaders, pioneers, in patient wellness.
So, when a patient comes in to one of the hospitals, the system kicks into action, to aid and enable accurate diagnosis, and determine the most effective course of action.
A range of tests are performed - the standard ones of blood sugar, lipid profile, kidney and liver function tests, the ECG, Echo, among others, as well as specialised tests such as the angiogram, the BNP - Brain Natriuretic Peptide - which is a sign of excessive stretching of the heart muscle, and is one of the symptoms of heart failure, Imaging of the heart using left or right catheterization, pulmonary blood pressure tests, among others, to rule-out, or “rule-in” heart failure.
All these tests are performed to determine the myocardial viability of the heart - judging whether the heart muscle is well enough, and is capable of functioning, or if the muscle is dead and needs to be replaced.
These tests then tell the cardiologist whether the patient needs a simpler, minimally invasive revascularisation of the heart - that is, ensure all the blood vessels flowing into the heart are clear of blocks, and blood flow is satisfactory, allowing the heart to resume functioning again.
Or a heart transplant.
Dr. Yusuf says, “The heart transplant is the last, and definitive treatment for Ischaemic heart disease.”
The first human heart transplant was performed in December, 1967 by Dr. Christian Baarnard, in South Africa, although there were previous attempts by doctors James D Hardy, Norman Shumway, and others. Early attempts at heart transplant weren’t entirely successful, as patients developed other complications, or the body rejected the new heart. Immunosuppression medication would have to develop, and newer drugs to hit the market, before the procedure became a viable, and effective treatment for end-stage heart failure.
The first heart transplant surgery in India was performed by Dr. P Venugopal, a surgeon and former director of the AIIMS, in August 1994. Soon after this, and after the Transplantation (Human Organs and Tissues) Act of 1994 was formally passed in the Parliament, Apollo Hospitals in Chennai performed the first heart transplant in the south. Since then, the hospital has performed over 64 transplants - a record number for a single-centre transplant.
Today, the science and the medical system has developed to a stage where, as Dr. Yusuf puts it, the ‘mortality risk’ for transplant is less than 10%. Most patients receiving heart transplants now, are able to live a worry-free life. Today, about 70% of those who have received heart transplants, survive with no additional complications or problems.
Part of this is to use transplantation is only the last option in the fight against heart diseases. Dr. Yusuf says, “We have to assess myocardial viability - that is the heart muscle is all dead. If the heart muscle is viable, then we can do angioplasty or CABG - known more commonly as bypass, and get blood back into the muscle to work. If there’s dead muscle, if whatever we do is not going to help, that’s when we have to get rid of the muscle and put new muscle in. Putting a new heart.”
Greater awareness, and a system of care
Dr. Yusuf says, “The advent of better immuno-suppression, and increasing awareness in India to organ donation, is benefiting more patients here. The awareness is particularly high in Chennai and in the south.”
This has taken a lot of effort, on the part of cardiac surgeons like Dr. Yusuf, and institutions like Apollo, to achieve. In creating processes that put patients and their needs on high priority, in developing care and outreach programmes for donors and their families, in fostering partnership between the hospitals, research centres, and the government, in facilitating and governing transplantation in the city, and in the county.
There is a Transplant List for the state of Tamil Nadu. The state is divided into 3 different sub-regions, and priorities are established for patients. Working across the networks, doctors and government officials have managed to reduce the waiting time for each patient to about 1 month. However, in cases of emergency, doctors escalate the priority. The goal as always is to save lives.
Dr. Yusuf, who performs about 12-15 heart transplants in a year, is also part of the International Society for Heart & Lung Transplant. The organisation is headquartered in the USA, but is the authority on heart transplants around the world. It puts out a guideline for this extremely critical surgical procedure, and monitors quality standards around the world.
The ISHLT also maintains a registry of patients and donors, and will try to match requirement with availability as quickly as it can.
Membership to ISHLT - and Apollo was the first Indian hospital to be part of this - allows Dr. Yusuf to share his experience with the world, and bring global best practices to India. The protocol and systems Apollo follows for heart transplant, is transparent and scrutinised by ISHLT throughout the year, translating to better care and support for patients.