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Insights from the world's best medical minds

ECMO ( Extracorporeal Membrane Oxygenation And VAD ( Ventricular Assist Devices) : Two Options For A Failing Heart That Serve As A Bridge To A Heart Transplant

Dr. Poonam Malhotra
Dr. Poonam Malhotra, Additional Professor,Cardiac Anaesthesia,AIIMS,New Delhi,Options available for failing heart
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Dr. Poonam Malhotra

Additional Professor,Cardiac Anaesthesia

AIIMS,New Delhi


The options available are an intra-aortic balloon pump, which does not build up the mean diastolic pressure beyond 75 mmHg though it does augment the diastolic coronary pressures. But at the same time, awaiting a heart transplant can be very-very traumatic and disastrous for the patient and his family while the cardiac output and the heart continues to fail


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Complete Transcript

The Indian scenario rich to transplant

When we have a failing heart with an NYHA III or IV dilated cardiomyopathy which is waiting for a heart transplant what are our options available for such a patient. Most of them are on supraoptimal medical therapy which does not build up their cardiac output. The options available are an intra-aortic balloon pump, which does not build up the mean diastolic pressure beyond 75 mmHg though it does augment the diastolic coronary pressures. But at the same time, awaiting a heart transplant can be very-very traumatic and disastrous for the patient and his family while the cardiac output and the heart continues to fail. In such a scenario at AIIMS, the ORBO, the NOTO and many other organizations across the country such as the Fortis Group of Hospitals, (01:00) Max Saket, Vedanta, Narayana Hrudayalaya, has come up with brilliant therapies on two emerging modalities ECMO and the ventricular assist devices. It was in 2000 that the echo programs started at AIMS New Delhi. The first heart transplant was also done successfully by Dr. Venugopal and his team at AIMS, New Delhi and since then we have had more than 60 heart transplants performed at the center successfully with more than 50 patients still there, but while this was going on and our waiting list was emerging to be more than 25,000 every month the other probabilities that came up for ECMO and VAD and it was in 2000 soon after the success of the heart transplants came in the center that the ECMO program was rolled in. Early mortality was in with the ECMO and this was chiefly (02:00) the venoarterial ECMO which was done on pediatric cardiac surgical patients. The integrated ECMO which started on patients with ALCAPA, with heart failure or patients with obstructed TAPVCs or D-TGA with intact ventricular septum was also done very successfully making the mortality from 70% to be 30% in 2014 and the ECMO success at AIMS shows that while we do one to two patients which are chiefly pediatric venoarterial ECMOs the success of ECMO is here to stay, while the patient awaits a heart transplant, a patient can be temporarily with a reversible cause be put on ECMO for up to one to three weeks and then switched on while a good donor is available to a good VAD, a ventricular assist device which could be left ventricular or a right ventricular or a BIVAD. The Impella Recovery the (03:00) HeartMate III with so many new percutaneous ventricular resist devices along with ECMO give success to bridging the patient awaiting a heart transplant. Heart transplant is the only definitive therapy available for this dilated cardiomyopathy which is dreaded fatal disease. So while your patient is waiting resort to a good center near your place for ECMO and LVAD. Across these centers in the country it is places like AIIMS, New Delhi, places like Fortis Chennai, places like Max Saket where ECMO is in I am not advertising these places, but I am telling your for general population be aware that organizations like ORBO, NOTO and all such centers will take care of your patients (04:00) for ECMO, for VAD and do a successful heart transplant. Be on the list and they will inform you when a right donor is available which to transplant with ECMO and VAD is in vogue , kindly seek more answers on the net.




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