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In a heart transplant, the norm is to perform five complete anastomoses — surgical connections between arteries and veins of the heart — before supplying blood to the heart. But because the doctors were running out of time because the heart arrived five hours and 10 minutes after retrieval from the cadaver donor, they performed two complete anastomoses and two partial ones before opening blood supply.
“The remainder of the connections were created on a perfused, beating heart, which is difficult because the heart is already beating and there is a fair amount of blood coming out of the connections,” Dr Sujay Shad, senior consultant and director of cardiac transplant at SGRH, said. He added the whole process was completed in 50 minutes when usually a transplant takes 90 to 100 minutes.
The doctors said they had to perform the surgery at super-speed because the heart arrived at the hospital after five hours of its retrieval when the gold standard is to finish heart transplant within six hours for better outcome.
“Normally, transplanted heart starts functioning on the completion of the procedure. However, in this case, it took about 24 hours to gain strength. We had to give drugs to boost blood pressure and cardiac function and nitric oxide to support the function of the right heart,” Dr Shad said, adding that once the patient started improving, there was no looking back. Trehan was discharged from SGRH on Wednesday, three weeks after the transplant. Asked about the reason for delay in transportation, doctors said the hospital received a call from the National Organ and Tissue Transplantation Organisation on May 23 informing about the availability of a heart.
“There is no direct flight to Madurai, so we arranged for a chartered flight. But before it could fly out, the donor had to be shifted to the operation theatre for retrieval of lung and other organs. We requested surgeons retrieving the lungs to harvest the heart for us, bag it appropriately and provide that to our team of doctors reaching in few minutes in a cold box,” a doctor said. He added that the recipient was already connected to heart lung machine and within minutes of the arrival of the organ and a quick examination of its condition, the donor heart was transplanted.
