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Heart transplant doctor gives ‘game changing’ presentation to Gib uni

Dr Lewis Cardiac Lecture 010219 (Photo John Bugeja )

A heart transplant doctor who treated local man Louis Casciaro gave a presentation on ‘game-changing’ technology in a bid to raise awareness for the Gibraltar Cardiac Association.

At 58-years-old Mr Casciaro received a life-saving transplant thanks to the cutting edge technology provided by Dr Clive Lewis and the Royal Papworth Hospital.

Dr Lewis, a cardiac transplant physician from the Royal Papworth Hospital, specialises in advanced heart failure, cardiothoracic transplantation, mechanical circulatory support and congenital heart disease.

He gave a presentation at the University of Gibraltar as part of Gibraltar Cardiac Associations ‘heart month’ awareness campaign.

A recent development in heart transplants has seen doctors at the Royal Papworth Hospital perform transplants with hearts previously deemed unviable for transplantation.

The Hospital was successful in transplanting a ‘non-beating-heart’ into a patient some three years ago. A non-beating-heart is a heart that ‘died’ and stopped beating for five minutes.

Previously hearts from donors that where brain dead would be used.

Mr Casciaro was the 18th person to receive this treatment.

The hospital has successfully transplanted over 50 non-beating-hearts and this cutting edge method has resulted in the hospital increasing its annual transplantation rate by a third.

Before this new technology some 35 hearts on average would be transplanted at the Royal Papworth.

Now the hospital is transplanting over 50 hearts a year as more hearts are viable.

Dr Lewis described how new technology has seen hearts kept at body temperature and pumping instead of on ice.

“Now it’s not on ice and cold, but at body temperature and beating,” Dr Lewis said.

“We have technology called organ care profusion system which allows the heart to be put on a special rig where we give oxygen nutrients and get the heart beating again. Within a sterile environment at the correct body temperature the heart is then transported to the recipient hospital beating.”

He described how doctors then check whether the heart is viable and if it is in a good condition prepare it for transplantation.
“It has been a game-changer for us because it has allowed us to use hearts that clearly weren’t being used,” Dr Lewis said.
He explained that is possible as there are two defined legal ways of dying.

The first being brain stem death where the heart is still beating but no neurological reactions. In this case the patient is typically hooked to a breathing machine which keeps their heart pumping.

The second is where the heart stops for five minutes – in the past these donors would have never been used for heart transplantations.

“It had never been done for the heart, so what we pioneered over the last three years is to take those hearts which have stopped beating and then transplant them,” Dr Lewis said.

“We were worried whether they would work or not. The way we got around that was using this machine to put those hearts on the machine and restart them to see whether they would work or not.”

“We have had some very brave patients. One of them was from here in Gibraltar, who has had this new technique using hearts that would have never been used.”

Until three years ago this operation had never been done before.

“We couldn’t have been able to do it without those brave patients who said yes,” Dr Lewis said.

Since then doctors have found no difference between the patients with beating and non-beating heart transplants.

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