Biventricular Berlin Heart Implantation, First in MESA at MGM Hospital Chennai

Chennai: A hospital in India has become the first center to perform artificial heart transplant (Berlin Heart Implantation) on a child with heart failure. Complex artificial heart implant procedure was done for the first time in Southeast Asia, Middle East& Africa (MESA) 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 first of its kind, Berlin Heart Implantation was performed over seven-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.

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 performed the procedure on May 25, 2020. 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.

Dr Balakrishnan said,“This was a huge challenge, given the prevailing circumstances. Berlin Heart will support the circulation of this child till the heart recovers or he gets a transplant. Post implant, The baby was kept under observation for a few weeks. The child has recovered remarkably well and has gained weight in a very short time and has been discharged from the ICU. He is doing absolutely fine now.”

The Baby Patient

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 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 hospitalisation 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”.

Berlin Heart Implantation 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 teleconference to support the team in Chennai, notwithstanding the physical barriers imposed by COVID-19.

This complex surgical biventricular Berlin 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 the Far East. This is also the first recorded time in the world, that this complex procedure has been done with complete virtual support.

Speaking on Berlin Heart procedure Dr. Suresh Rao said “Newborns with heart failure or children suffering from severe heart insufficiency don’t really have much of a choice. A heart transplant most of the time is the only survival possibility.    The problem the doctors are facing is that there is hardly a chance to keep their patient’s condition stable until heart transplant becomes possible. Waiting times are much too long until donor hearts become available. The demand for life-saving heart assist devices, which could bridge the time by mechanically supporting the heart function, is enormous.”

What is Berlin Heart

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.