the recipient is prepared they're wheeled down to the operating room the heart has been removed from
a donor body the time limit is critical the operation involves removal of the old heart and replacing it
with a new donor heart the various connections are switched in and the heart is reperfused and it is
one of the most rewarding event that a physician can see the new heart waking up the first beat
[Music]
heart failure is a condition in which the cardiovascular system is unable to meet the body's
needs for blood and oxygen if a patient's heart is failing medical or surgical options they may
be considered a candidate for a heart transplant after an evaluation that classifies their priority
the patient is placed on the heart transplant waiting list until a suitable donor heart becomes
available organ transplantation is one of the greatest Feats of modern medicine however what
is now reasonably successful in standardized transplant process was not always so safe or
straightforward 1905 the first heart transplant was attempted with two canines the recipient dog
only lived two hours after the experimental procedure 1953 the first heart lung machine
was used for heart surgery a machine taking on the work of the heart and the lungs so that the heart
can be operated on one of the major developments that made heart transplant surgery possible
1954 the first human organ transplanted successfully was the kidney in Boston
Massachusetts immune suppression wasn't needed as the transplant was between two identical twins
July 19 1963 e Stanley Crawford and Domingo Liotta implanted the first clinical left ventricular
assist device also known as an lvad at the Methodist Hospital in Houston Texas and a patient
who had a cardiac arrest after surgery December 3rd 1967 Dr Christian Barnard performs the first
successful human to human heart transplantation the post-operative course of the patient was
very promising but contracted ammonia and died 18 days later January 9 1970 Dr John Ochsner senior
performed the first heart transplant in the Gulf South September 3rd 1983 cyclosporin and
immunosuppressant is granted FDA approval in heart transplant surgeries tackling rejection issues
cumulative survival rates were raised and heart transplantation would gain worldwide acceptance
May 1987 the first Domino donor operation is performed a 28 year old man with cystic
fibrosis and end-stage lung disease received the heart and lungs of an anonymous donor after he
donated his own harsh to a 38 year old man with end-stage ischemic cardiomyopathy June 1996 a
patient received the world's first successful combined heart and kidney transplantation after
bridging with a total artificial heart by Dr Yang Wei 2014 world's first adult non-beating heart
transplant is performed using a heart in a box or a machine perfusion [Music] heart failure is
a state in which your heart is unable to provide circulation to meet your body needs you can have
something called systolic heart failure where your heart pump is not able to squeeze as effectively
as it should or you can have something called diastolic heart failure where your heart doesn't
relax properly and both of these types of heart failure lead to fluid backing up in your lungs
or your abdomen or both causes your organs in your body to not get enough oxygen over time
sharpness of breath lethargy lack of energy weight gain mainly water Builder swelling of their legs
there are many factors that can cause heart failure some of them could be related to
inadequate amount of blood flow to the heart itself some could be as a result of the valves
within the heart not functioning properly some as a result of medications some as a result of
illicit drugs viruses and some of the factors that we are still studying there is a genetic
component so it can run in families there are also patients that might have another disease process
that leads to the left side of their heart not working properly like sarcoidosis and of course
patients that have had heart attacks that have blockages of heart arteries that then hurt the
main pumping chamber of the heart leading to heart failure the incidence of heart failure is
increasing it's a multifactorial cause people are in a lot more stress many changes over the last
few years have resulted in not seeking timely medical help and also there is more heightened
awareness amongst people about their health we are dealing with the sickest of the sick and
we do our best to support them by either going through heart transplant or getting a heart pump
a lot of what goes into heart transplant patients doing so well is the drugs that they take to
suppress their immune system so that their immune system does not attack their transplanted heart
the Advent of cyclosporine a medication that revolutionarized the outcomes that was
a moment that changed everything after that acrolimus came out and a third agent called
microfenylate mephettol and the combination really continues to be the Mainstay of our drug regimen
there are definitely more and more patients that come into the hospital with symptoms of
heart failure donor populations are low there aren't enough heart transplants to go around
the supply of these organs are extremely Limited as the wait list is long some patients who cannot
wait for heart transplantation benefit from hot pumps Mark used to be a very active individual he
was a physician assistant in the Orthopedics you know moving and managing heavy equipment
at about three o'clock in the morning I got up to go to the bathroom and I couldn't catch my breath
annetta was sleeping I've never gone to the hospital and I woke her up and said annetta
I have to go to the hospital I can't catch my breath I met Mr Nelson when his cardiologist
in his local area had reached out to us he had something called dilated cardiomyopathy
where the left side of his heart was not able to pump efficiently and at normal percentage I've
never smoked I haven't been overweight I've done everything I'm supposed to do but you know what
that's not how it goes we call that idiopathic dilated cardiomyopathy we don't understand
necessarily why it happened to him we may never find out we recommend that his children and his
first degree relatives get tested for heart failure as well in case there is a genetic
component he was a well-built guy but when I saw him he was extremely short of breath he could not
even complete his sentences his Labs showed that he was heading towards multi-organ failure and
is currently battling for his own life he slowly started to gain weight and it was weight that was
not related to eating food it ended up being water weight which can be one of the presenting symptoms
of heart failure my ankles my legs my hips would have pitting edema at the end of the day you
could just push on the skin and it would just leave big imprints of your thumbs from all the
fluid one of the main things that we do is to get that fluid back off again we also use medicines
that effectively drop blood pressure to take the pressure off the heart to see if that left-sided
pump can pump better and when those things don't work is when we talk about a heart transplant and
or an lvad she said your hearts going down fast don't know how long it's going to stay strong
enough for to even go through any type surgery it was no longer safe to undergo heart transplant
directly we implanted a temporary left ventricular cyst device and this is actually a very small
one and it actually will sit in the heart inside the heart in the aortic valve vads or lvads left
ventricular assist devices it's a pump that's surgically placed that helps pump the blood for
the heart it can be something temporary something small or it can be more often something permanent
which we implant by doing astronomy which we opens life from the midline of the chest cavity
heart pumps have really significantly impacted the outcomes of these patients the one year and
two-year survival after a heart pump is the same as that after the heart transplantation
they can still live a relatively normal life of course they have to deal with the batteries
and so you have to charge that but otherwise they're pretty symptom-free therapy in the
form of heart pumps can be used as a destination therapy or as a bridge to Heart transplantation
so we give somebody this device because we know that they're going to be stuck in the hospital
until they get a heart transplant and then that person will walk around and stay strong and then
we eventually get them a heart at 10 o'clock in the morning Dr Desai came back in the room with
her whole Entourage of people she said Mr Nelson we have a heart for you and it's a perfect match
I'm sorry man my life changed right then and there when you put a heart transplant in is
basically a foreign object to your body your body tries to attack in in response
dream focus and dedication of team members are needed
hot transplantation will be generally divide into five areas the hot recipient management the donor
pot management Transportation the actual operation of heart transplantation and the post heart
transplantation care how are you doing during the focus on the recipient management the recipient
is prepared for the surgery they're vealed down to the operating room and a surgical team starts
operation at the same time the donor team has been managing the maintenance of the organs such as the
heart so that the organs are well preserved the transportation team is crucial in managing the
timing from which the heart has been removed from a donor body at the time it gets switched
back into a recipe the time limit is critical four hours is the total amount of time that we all work
the operation in itself in walls removal of the old heart and replacing it with a new donor heart
the various connections are sutured in and the heart is reperfused and it is one of the
most rewarding event that a physician can see the new heart waking up good morning and after
that patients are taken back to the cardiacare units where the post-operative care is provided
patients wake up they get off the ventilator they start involving themselves in regular
physical activities tolerating a diet and are on anti-rejection medication and hopefully in
few days they're discharged home to their families brought them to the operating room we put them on
the heart and long machine and then we took out his old heart and then took out that temporary
left ventricular assist device and then you put a new heart in then he had a fantastic
post-operative course and he went home soon afterwards he had such a swift recovery because
he had been in good shape going into the surgery and I would say all of the care coordination
around the time of surgery and even when he went home was just excellent transplantation and Albert
therapies can provide a significant Improvement in the quality of life significant advancements
have happened over the last many decades that patients are able to get their life back
I think this is a very exciting time the newer advancements that we are working on one
is xenotransplantation in which modified animal Hearts can be used xenotransplantation has been
done and now recently was done successfully in the United States obviously we are in the nascent
stages of xenotransplantation second development of new heart pumps which are smart these smart
pumps are able to assess the need of the body and increase or decrease the flow as situation demands
and also fully integrated heart pumps in which all the components are internal there is no
power source that has to be supplied externally where does the power come from yeah so no it is
external wirelessly charged wirelessly yeah then it comes I'm telling you it is the next level
[Music]
[Music] [Applause] [Music] [Applause]