A Major Milestone for Heart Transplants

December 13, 2012

If they weren’t such a modest lot—and if they hadn’t been quite so tired—you might have heard the sounds of celebration at the University of Ottawa Heart Institute last month.

On November 23, 2012, surgeons at the University of Ottawa Heart Institute performed the 500th heart transplant since the program began in 1984. The transplant program includes a multidisciplinary team that provides care to patients, often for years prior to and after transplant.

It was an occasion truly worth celebrating—the Heart Institute’s 500th heart transplant since the program began in 1984. At the same time, they were counting the 498th and 499th. In fact, two records were set between November 22 and 23—not only the 500 milestone but also the first time three transplants had been completed in one 24-hour period; two of them actually overlapped, with two full teams working in parallel.

“It was a great time,” said surgeon Dr. Marc Ruel, “We were in a state of very positive elation.”

He compared the transplant process to something like Christmas. “You take out the old heart that isn’t working any more and you put in this new, usually younger heart,” he said. “It’s like a Christmas gift for the patient. We get a real adrenaline surge from it.”

The 500th heart transplant patient was already in the hospital, waiting for a heart, when one became available. He’d heard about the approaching milestone and told the staff he had a premonition that he would be number 500. “He represents all the great transplant patients we’ve ever had,” added Dr. Ruel.

Dr. Ruel has been performing heart transplants at the Heart Institute for more than a decade. Not much has changed during that time in terms of technique, he explained. The transplants performed November 22 to 23 were not substantially different from the first one performed in Canada, back in 1968. What’s changed is our understanding of the heart and how it operates. That has led to improvements in anesthesiology, in immunosuppression (necessary to keep the recipient’s body from rejecting the new heart) and in the treatment and rehabilitation process after the transplant.

It is these advances, outside of the operating room, that led to Dr. Ruel’s findings when, last year, he reported on research following up on all the patients who had had heart transplants at the Heart Institute since 1984. He and his colleagues found that survival rates from heart transplant have increased more than 20 per cent over the years, with the major changes coming after 2003. They found that nearly 90 per cent of recipients from that time were alive eight years post-surgery. And that, said Dr. Ruel, is better than pretty much all other published outcomes, testament to the high quality of care provided by the transplant team at the Heart Institute.

And, he added, he’s a very small part of that team. It’s the cardiologists and multidisciplinary team, responsible for care of heart failure patients prior to transplant and afterward who bear far more responsibility for those improved survival rates.

Cardiologist Dr. Haissam Haddad is Director of the Heart Failure Program and Medical Director of Heart Transplantation at the Heart Institute. He and his team see some patients for as many as 10 years before transplant and follow them for the rest of their lives afterward. In the first year after transplantation alone, he performs 10 to 12 biopsies on the patient, looking for signs of rejection so they can intervene early.

It’s a unique relationship,” said Dr. Haddad. “We see these people very often. We know them; we know when they’re not doing well. We suffer with them; we celebrate with them.”

Jackie Grenon agrees. An advanced practice nurse, Grenon is the coordinator of the transplantation program, the core that unites physicians, surgeons, dietitians, social workers, pharmacists, nurses, physiotherapists and all the other health professionals who together help heart failure patients survive and thrive. She said the patients and caregivers are like family, and her words were borne out by the atmosphere at a reception celebrating the transplantation milestone. Transplant recipients and staff members were hugging and catching up on one an others’ lives. The warmth and connection were tangible.

In the words of transplant recipient Daniel Shipman at that reception, “You have given us a chance to live with our family, our friends, to go on with your lives. You are my family.”

There are currently 67 people in Canada waiting for a heart transplant, according to the Trillium Gift of Life, the Ontario not-for-profit that coordinates organ donation. The wait can last for days or months, depending on the available hearts and the patients’ needs. The Heart Institute’s first transplant was performed in 1984 by surgeon and Heart Institute founder Dr. Wilbert Keon. Today, the Heart Institute is one of the top hospitals in Canada for heart transplants, performing nearly 30 each year.