A journey of 4000 miles in search of a heart

The first ever artificial heart implant (BIVAD from Berlin Heart) in South East Asia and Middle East.

The announcement of South East Asia & Middle East's First Biventricular Berlin Heart Implantation on a 3-Year-Old-Boy by Hon'ble Chief Minister of Tamil Nadu Thiru Edappadi K. Palaniswami In the presence of Hon'ble Minister for Health and Family Welfare of Tamil Nadu Dr C. Vijaya Baskar

About Berlin heart surgery

The Berlin Heart is used to take over the function of a child's own heart when it becomes too weak to pump sufficient amounts of blood to the lungs and/or around their body. There are many different types of conditions which can cause the heart to fail,the most common being a weak heart muscle (Cardiomyopathy) or an infected heart muscle (Myocarditis).

The Berlin Heart pumps blood around the body in order to keep the brain and other organs healthy, allowing the child to grow and get stronger. It will be required until the child is transplanted, or for a small number of children, until their own heart recovers.

MGM Healthcare performed a complex artificial heart implant procedure for the first time in South East Asia, Middle East & Africa involving two artificial heart pumps known as 'Berlin Heart' to support both the right and left side of the heart of a 3-year old Russian boy, weighing 10 kg. The procedure was performed on 25th May by a team led by Dr K. R. Balakrishnan, Chairman & Director of Cardiac Sciences and Director of the Heart and Lung Transplant & Mechanical Circulatory Support Program at MGM Healthcare. Other members of the team that performed the procedure, included Dr Suresh Rao K G, Co-Director - Institute of Heart and Lung Transplant & Mechanical Circulatory Support and HOD - Cardiac Anaesthesia, and cardiac surgeons Dr V. Srinath and Dr S. Ganapathy, Senior Consultants, MGM Healthcare. The team has performed the largest number of mechanical circulatory device implantation for heart failure management in India.

The first of its kind, Berlin Heart Implantation was performed over a 7-hour long marathon surgery in collaboration with engineering support teams from UK and Germany guided by state-of-the-art virtual technology due to travel restrictions imposed by the COVID-19 crisis.

Baby Lev Fedorenko suffered from a heart condition called restrictive cardiomyopathy wherein the walls of the lower chambers of the heart, called the ventricles, are too rigid to expand and receive any blood.

The parents of the baby flew him down to Chennai to consult with Dr K R Balakrishnan and seek possible solutions for their child's medical condition. He was initially managed with medications for around two months, but unfortunately his condition started worsening, and he became critically unwell and required hospitalization at MGM Healthcare. He continued to deteriorate and had two episodes of cardiac arrest, where the heart stopped beating and had to be resuscitated with manual compressions for several minutes. The only option possible for such a small child was an artificial heart pump and since both the right and left side of his heart were affected, he needed two heart pumps. Small pumps for such a small child known as Paediatric Biventricular pump are made only in Germany by a company called "Berlin Heart".

Implantation of the "Berlin Heart" in a little child was always going to be a mammoth task. It was a challenge to fit the cannula needed for the pump inside the small chest cavity of this child. The surgery was also complicated by the fact that it was performed amidst a period of complete lockdown in the city of Chennai, at the height of COVID 19 pandemic. Additionally, managing anesthesia and surgery in such a small child wearing the mandatory personal protection equipment warranted the best of clinical expertise. Experts from multiple backgrounds and countries joined via tele-conference to support the team in Chennai, notwithstanding the physical barriers imposed by COVID-19.

This complex surgical biventricular heart implantation is the first such implant in South Asia, South East Asia and among the few in the whole of Asia stretching from the Middle East to Far East. This is also the first recorded time in the world, that this complex procedure has been done with complete virtual support.

The Berlin Heart VAD consists of a plastic pump or chamber which is outside of the body. It has a blood-filled side and an air-filled side, separated by a flexible membrane. The blood-filled side of the pump is connected directly to the child's own heart and main artery by means of two tubes or 'cannulae'. The air-filled side of the pump is connected via a long plastic tube or 'driveline' to a driving unit. The driving unit of a Berlin Heart drives air into and out of the heart pump(s). As air is pulled out of the pump, the membrane separating the two sides of the pump is drawn back, pulling blood into the pump from the main pumping chamber of the child's own heart.

Berlin Heart GmbH is the only company worldwide which develops, manufactures and distributes both implantable ventricular assist devices for patients with heart diseases. The systems INCOR, EXCOR Adult and EXCOR Pediatric support short- to long-term pumping function of the heart and thus present a life-saving therapy possibility for the patient. MGM Healthcare is the only hospital in South East Asia, Middle East & Africa to use this device to perform a lifesaving surgery.

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