Heterotopic heart transplant: relevance as Bio-VAD in emerging economies

Despite the introduction of mechanical circulatory assist systems in India two decades ago, there has not been their wide usage due to two main reasons: (1) economic-financial unaffordability and (2) lack of social support. There have been a number of significant steps taken by the government and by the media for augmenting awareness for organ donation. A sizeable donor pool in India falls into the category of marginal donors, due to a variety of reasons like geographical distances, lack of rapid transport, suboptimal donor management due to the lack of resources, and trained manpower in hospitals where donor harvest is done. Consequently, the usage of the heart as a donor organ is less than 20% in India. There is a lack of statistical data regarding the usage of heterotopic heart transplants, due to the absence of a registry, since the procedure is rarely performed, and comparative results are difficult to obtain due to different subsets of both donors and the recipients. The original papers by Barnard and Cooper cannot be extrapolated in the modern context, as these publications were in the pre-cyclosporin era. Orthotopic heart transplantation (OHT) is a well-established and commonly utilized procedure for patients with end-stage heart failure. Heterotopic heart transplantation (HHT) is a surgical procedure that allows the graft to be connected to the native heart in a parallel fashion to provide a kind of biological biventricular or univentricular (left ventricular support). It was performed first in human beings by Barnard in 1974 [S, J., 49:, Afr, Med, 1975, 303-12].