Лучшие больницы для «Heart Transplant» в Мумбаи, Индия

End-stage heart failure (NYHA Class IV) represents a state of irreversible myocardial damage in which the left ventricle — and often the right — can no longer generate sufficient cardiac output to meet the body's metabolic demands. Conditions most commonly leading to this point include ischemic cardiomyopathy (prior to or following myocardial infarction), dilated cardiomyopathy (idiopathic, viral, or familial), restrictive and hypertrophic cardiomyopathies, and complex congenital heart disease refractory to repair. Hemodynamically, patients exhibit severely reduced ejection fraction (typically EF < 20–25%), elevated pulmonary capillary wedge pressure, low cardiac index (< 2.0 L/min/m²), and often pulmonary hypertension — all of which contribute to progressive multi-organ dysfunction including hepatic congestion and renal impairment.

• ELIGIBILITY — MEDICAL INDICATIONS:
• End-stage heart failure (NYHA Class III–IV) with persistent symptoms despite optimal medical therapy (OMT) for ≥ 3 months
• Left ventricular ejection fraction (LVEF) ≤ 25–30% with high predicted 1-year mortality (HeartMate II Risk Score, HFSS, or MAGGIC score)
• Ischemic cardiomyopathy, dilated cardiomyopathy, hypertrophic cardiomyopathy, restrictive cardiomyopathy, or complex congenital heart disease not amenable to conventional repair
• Refractory ventricular arrhythmias unresponsive to antiarrhythmic therapy or ICD
• +33 more

STANDARD ORTHOTOPIC HEART TRANSPLANTATION (OHT) — BIATRIAL vs. BICAVAL TECHNIQUE:

The bicaval technique (Sarsam-Yacoub modification) has largely supplanted the classic biatrial technique (Lower-Shumway) at high-volume centers. In the bicaval approach, the donor superior and inferior venae cavae are anastomosed directly to the recipient's own caval remnants, preserving right atrial geometry, sinus node function, and reducing the incidence of tricuspid regurgitation and post-operative arrhythmias (particularly atrial flutter). The surgical sequence involves median sternotomy, cardiopulmonary bypass (CPB) with cardioplegic arrest, cardiectomy (leaving posterior left atrial cuff and pulmonary veins), followed by sequential anastomosis of the donor left atrium (or individual pulmonary veins), inferior vena cava, superior vena cava, pulmonary artery, and ascending aorta. Cold ischemic time must be minimized — ideally < 4–6 hours — to reduce primary graft dysfunction (PGD).

Heterotopic HEART Transplantation (piggyback TECHNIQUE):

Rarely performed (< 2% of transplants globally), this technique places the donor heart in parallel with the recipient's native heart in the right hemithorax. It is reserved for patients with severe, irreversible pulmonary hypertension (elevated but not fixed PVR) where the donor right ventricle alone may be unable to sustain pulmonary circulation, allowing the native right ventricle to assist with pulmonary vascular load. It is also considered when donor heart size is significantly smaller than the recipient.

PHASE 1 — INITIAL EVALUATION AND LISTING (Weeks 1–4 prior to transplant):

• Step 1 — Remote Pre-Screening (Before Travel): Submit medical records, echocardiography reports, cardiac catheterization data, and recent laboratory results to GAF Healthcare's medical team. A senior transplant cardiologist reviews eligibility within 48 hours.
• Step 2 — Arrival and Comprehensive Transplant Evaluation: Upon arrival in India or the UAE, the patient undergoes a 5–7 day structured evaluation: right heart catheterization, CPET, HLA typing and PRA testing, full organ function panel, psychosocial assessment, infectious disease screening, and multidisciplinary transplant committee (MTC) review.
• Step 3 — Listing and Waiting Period: Upon MTC approval, the patient is listed on the national/regional transplant registry (NOTTO in India; DOH Transplant Authority in the UAE). Wait time is unpredictable — days to months depending on blood type, body size, and donor availability. Patients requiring inotropic support or LVAD implantation may receive expedited listing priority.
• Step 4 — Bridge Therapy (If Required): Patients in hemodynamic decline may undergo HeartMate 3 LVAD implantation as a bridge to transplant, allowing safe waiting in a more stable clinical state.

PHASE 2 — TRANSPLANT SURGERY (Day 0):