Heart Failure

Hi,

My name is Dr. Viveka Kumar. Today I am going to speak on and discuss with you regarding the most difficult disease to manage and that is heart failure. As you would know, India is capital of heart failure and we are seeing more and more patients coming with systolic heart failure, low ejection fraction and there is nothing which can be given to them till now. But now, we have got newer treatment options apart from ICD and Cardiac Resynchronization Therapy. We can offer them the left ventricular assist device and the heart transplantation. We have been doing you know regular left ventricular assist device and heart transplantation and a heart transplant is a definitive treatment like you know the renal transplant for kidney patients and liver transplant for liver patients. So that is the way our transplant works and in younger patients, it supports, so the survival up to 10 years is more than 80% and these the patients can lead an absolutely normal productive life.

Having said that, all our patients who would not get the suitable heart because God has given only 1 heart in a fit human being unlike the kidney, so we need to wait for the brain-dead patients or those who have got, you know road traffic accident or has a severe stroke. So, in these situations, we have to wait and find a suitable donor. But heart failure patients cannot wait for very long. So, we had a what we called is left ventricular assist device. Initially, it started as a base to transplant therapy where we would give the patients you know the left ventricular assist device or biventricular assist devices and wait for 6 months or a year till the patient gets the new heart and then transplant and remove the left ventricular assist device. But the scarcity is so much that we have ventured into what we call destination therapy left ventricular assistive devices which can be given and work as a permanent.

So, it works like a good device in for you know it sucks out the blood from the left ventricle and pumps in the aorta and all the organs get the blood supply and the cardiac output could be anything from you know 4.5 - 5.5 liters as per you know setting of the device. So that's again as you know destination therapy, we have lots of patients who are on you know 4 - 5 years with this therapy and they are doing absolutely fine. So, these are the things which we need to you know offer these patients so those who are younger they can go to this treatment and they can lead a normal and productive life. So, it's a complex disease where a team of cardiac surgeons, cardiologist, heart failure specialist and electrophysiologist and clinical cardiologist we work together and find a suitable treatment for our patients and offer them.

So, we should not be saying that you know the patient if he has got severe heart failure, its end of the therapy and we can't offer them. We have a lot of newer pharmacotherapy also like ARBs and beta-blockers and spironolactone all these things can also delay the progression of heart failure and slow down the attrition rate and on top of that if we give the devices in the form of cardiac resynchronisation therapy, appropriate patients the ICD in appropriate patients and also the offering them left ventricular assist device or biventricular assist device or end of the day heart transplant therapy, then we can save a lot many cardiac patients who can benefit from this therapy where life is improved. So, in the end, I would say that we need to you know do a team-work, identify the correct patients and advise them if they do not have you know correctable cardiac diseases then we should advise this form of therapy and they should be benefited from this therapy.

Thank you very much