Marengo CIMS, Ahmedabad performs the first bloodless heart transplant in Asia
· This protocol coupled with exceptional surgical skills enables patients to be discharged in just nine to twelve days as compared to the usual 21 to 24 days
New Delhi, Marengo CIMS Hospital, part of the Marengo Asia Hospitals Group, has marked a significant advancement in heart transplants by performing the first bloodless heart transplant in Asia. This surgical procedure pioneers a protocol of goal-directed bleeding management leading to transfusion-free heart transplants.
Dr Dhiren Shah, Director, Heart Transplant Program, Dr Dhaval Naik, Heart Transplant Surgeon, Dr Niren Bhavsar, Cardiothoracic Anesthetist, and Dr Chintan Seth, Heart Transplant Anesthetist and Intensivist at Marengo CIMS Hospital Ahmedabad led the team to accomplish the outcomes successfully.
The surgery was performed on a 52-year-old Indian patient, Mr Chandraprakash Garg, suffering from Ischemic Dilated Cardiomyopathy and end-stage heart failure. The donor was a 33-year-old who lost his life in a road traffic accident. Surgeries such as high-end heart transplants require a high amount of blood for transfusion as there is a significant amount of blood spillage during the surgical procedure. During high-end surgeries, blood transfusion can lead to potential risks and complications. Blood is also an organ and transfusion is considered to be an organ transplant in itself, to be completely monitored and controlled.
Marengo CIMS Hospital followed appropriate protocols to achieve this distinguished feat successfully. In these surgical procedures, meticulous surgical techniques are applied, following tailored protocols to reduce surgical blood loss to the point where transfusions become unnecessary. Bloodless heart transplant surgeries are remarkably intricate, requiring highly skilled medical professionals with extensive experience. The success of these procedures hinges on precision and accuracy, as they involve careful assessment and control of blood loss, ultimately obviating the need for blood transfusions.
Notably, the patient who underwent this highly innovative protocol therapy was discharged in just nine days, in stark contrast to the conventional heart transplant patient who typically requires 21 to 24 days at the hospital before discharge. With this clinical outcome, Marengo CIMS Hospital will be amongst the top 10 global institutes to perform absolute Zero blood transfusion in a highly complex heart transplant life-saving procedure. Zero transfusion also ensures significant mitigation of short- and long-term transfusion-inflicted complications along with reduced length of stay and overall improvement in clinical outcomes. There are patients with the challenge of their bodies not accepting external blood transfusions. For these patients, allowing no scope for heart transplants with this rarity, this therapy offers significant hope for heart transplantation.
Dr Dhiren Shah, Director – Heart Transplant Program, Marengo CIMS Hospital says, “A blood transfusion-free heart transplant represents a remarkable milestone in cardiac surgeries and showcases the significant strides made in surgical techniques and technology. We are setting up a Hemostasis Center of Excellence by adopting the bloodless heart transplant technique. The most crucial and clinically proven cornerstone of Patient Blood Management (PBM) is Goal-directed bleeding Management (GDBM). With proven accomplishments in Australia, the US, and Europe, the adoption of GDBM ensures a reduction in blood transfusion by up to 90%, overall length of stay by 70%, complications like infections or kidney damage by 70% providing more efficiency to doctors and time for patient management with an overall improvement in patient outcomes.”
Dr Niren Bhavsar, Cardiothoracic Anesthetist, Marengo CIMS Hospital says, “A cardiothoracic anesthetist has a critical role to play where the goal is to avoid the need for blood transfusion. From assessing the medical history of the patient, co-morbidities, and overall health conditions, the anesthetist works with the transplant team to manage anemia, nutritional support, and other interventions to reduce the need for transfusion.
The anesthetist has to carefully choose the type and dosage of anesthesia to maintain stable hemodynamics and minimize bleeding throughout the surgery which also translates into meticulous hemostasis. Continuous monitoring of the patient’s vital signs and other parameters, managing blood pressure, and coagulation parameters, and administering medications that promote clotting are additional responsibilities of the anesthetist. But the most important role is collecting the blood loss during the surgery, processing it, and reinfusing it in the patient’s body. The role is multifaceted and requires close collaboration with the surgical team for safe and optimal outcomes.”
Dr Chintan Seth, Heart Transplant Anesthetist, and Intensivist, Marengo CIMS Hospital says, “Because there was no blood transfusion, a lot of its deterrent effects were not seen in the postoperative period and the patient had safe sailing and was discharged on the ninth day.”
Marengo CIMS Hospital and Werfen have jointly set up a Coagulation and Hemostasis Lab as part of the Marengo CIMS Centre of Excellence roadmap in Cardiology, Stroke, and Trauma.
Dr Keyur Parikh, Chairman, Marengo CIMS Hospital says, “Marengo CIMS Hospital has created history by performing Asia’s first-ever blood transfusion-free heart transplant. This achievement reiterates Marengo CIMS Hospital’s position as a formidable and pioneering force in the healthcare sector, dedicated to introducing innovative procedures and techniques that align perfectly with their core philosophy of ‘Patient First’.”
Mr. Anurag Mishra, Regional Director, India, and South Asia, Werfen says, “We stand committed to extending global expertise and local support to take this patient-centric collaboration with Marengo Asia Hospitals Group to the next level. We have witnessed a notable positive outcome in the recent case of a 52-year-old patient with end-stage heart failure and subsequent transplant. Werfen will continue to create awareness and adoption of this multidisciplinary approach of Patient Blood Management that significantly minimizes the need for blood transfusion in all high bleeding surgical procedures.”
Complex cardiac surgical procedures necessitate the practice of transfusing blood to the patient but very often the transfusion can lead to adverse effects, including severe and long-lasting complications for the patient. The most sustainable, cost-effective, and evidence-based approach for minimalizing blood transfusion, and hence improving patients’ outcomes (such as decrease in the length of hospital stay), is to implement the principles and practices of Patient Blood Management, which is strongly recommended by WHO.
