It takes a confident, self-driven medical specialist with an unorthodox mindset to truly challenge the norm and establish world-class excellence in cardiac procedures, which is why U.S.-based Dr. Valluvan Jeevanandam, MD, is in a league of his own. Since joining the University of Chicago Medicine in 1998 to resuscitate its cardiac surgery department, the Chief of Cardiac Surgery at the health system has redefined the way heart transplants are being performed in the United States.
As he continues to lead some of the country’s breakthrough procedures with his expert knowledge, three decades of experience, and a never-ending thirst to raise the life expectancy of cardiovascular patients, UChicago Medicine has become officially recognised as the best medical centre offering the shortest waiting time for receiving a donor heart and the best survival rates in the United States for heart transplant patients. It also offers advanced bloodless cardiac surgery, which has come to the aid of several underserved communities and is home to the best robotic surgery program in the world.
Dr. Jeevanandam, who is also Director of the Heart and Vascular Center at UChicago Medicine, has performed over 1,500 transplants and been a part of unique medical feats such as a complex back-to-back triple organ transplant performed on two patients within 27 hours. The Chief of Cardiac Surgery and UChicago Medicine’s Advanced Heart and Vascular Center are a force to reckon with. Excerpts from the interview:
Changing the clinical mindset of transplants
Dr. Jeevanandam explained that a cardiac transplant is divided into different phases — identification and proper timing to refer a patient, getting the patient to the transplant, acquiring donor hearts for them (which is the rate-limiting factor), and finally, identifying how to maintain patients after the transplant to ensure the longest possible care.
“For the first part, we still have a large issue in identifying the proper patient for transplant. When they come in, one of the biggest questions a cardiologist faces is: ‘are they sick enough for transplant?’” he said, adding that cardiologists make treatment decisions based on the symptoms described by patients, who tend to downplay certain factors. As a result, medicines are prescribed for different things that keep prolonging their heart failure status to a point where other organs – kidney, liver, lungs, etc. — cease to function.
“I think this is one of the biggest problems that we have within any healthcare system — in the nation and internationally. But while the identification of a proper transplant candidate remains a big challenge, this is something that can be improved with proper education.
Dr. Jeevanandam added that a cardiologist’s confidence in the procedure plays a major role in changing the current landscape and transplants should not be considered a “last-ditch effort” anymore.
“If you look at the state of transplants now, we are not talking about expected one- to five-year survival but a 10- and 20-year survival. We are already familiar with the half-life of a heart — we know that 50 percent of those patients whose heart survived the first year now live past 15 years,” he said.
To put this into perspective, a 60-year-old male with any form of heart disease has a greater mortality rate in 10 years than if he were to get a transplant. He emphasised that medical professionals should be thinking about adding decades to a patient’s life, instead of a few years.
Heart transplant is not an experimental procedure anymore, but it is still a limiting one. Not enough hearts are available due to the limited number of organ donors.
“In the United States, we only conduct around 3,200 heart transplants on a yearly basis. It would be great to be able to do more with education and ongoing campaigns by professionals,” he added.
There are some exciting alternatives on the horizon, including new pumping devices that can prolong life. Dr. Jeevanandam also highlighted post-operative management as an important component of transplants.
“Our medications are improving and are less toxic. More importantly, we are developing methods to determine a rejection of a heart post-surgery. In the past, this used to come from biopsies, but now we have different molecular techniques that check if there is damage to the heart and if the DNA of the transplanted heart is in the patient’s blood. Nano portions of DNA can be detected to help identify rejections much early on and that is going to improve long-term results after transplantation,” he said.
Going beyond the norm
UChicago Medicine is geared toward greatness with Dr. Jeevanandam serving at the core of its Heart and Vascular Center. In 2015, he sparked a collaboration between cardiac surgery and cardiology, which aimed to change the narrative in heart transplants.
“If we really want to be at the forefront, then we need to be able to take on very difficult patients and have great results. And so, we developed protocols in terms of preoperative assessment, listing criteria for patients and for post-operative management. It is an ongoing, living document that is reviewed weekly.”
Dr. Jeevanandam and a team of around 50 healthcare professionals review a portion of the document every week, which includes analysing the literature, others’ medical experience, and their own experiences to update the criteria. This initiative has given high-risk patients a new lease on life.
Through this, UChicago Medicine has established several state-of-the-art procedures that helped patients whose conditions are often turned down by other hospitals. Among these is complex and innovative bloodless heart surgery. This takes on a personalised approach and caters to conservative and underserved patients that cannot opt for transfusions or replacement blood products due to religious or personal reasons.
In a final note, Dr. Jeevanandam said that raising the standard of heart transplants in the country requires a combination of trust and aspiration along with foundational protocols. “My philosophy is to do something different, innovative, and at the forefront, to help society. I wake up in the morning every day and ask myself: ‘what am I doing special today?’”
Dr. Jeevanandam is gifted with a pioneering spirit that draws motivation from things others cannot do. He strives to succeed by doing extraordinary things with a sense of spirituality that has allowed him to learn from failures. “A lot of it has to do with faith and intuition, instead of following what other people tell you. Intuition, after all, is a combination of your past experiences that are congregated in the depths of your brain,” he concluded.
Mark your calendar
The University of Chicago International Conference on Organ Transplant will take place on June 11 at the Grand Hyatt Hotel in Abu Dhabi, UAE. Visit www.menaconference.com/events/ucicot/ for more details.
