First female heart transplant

A young mother has been given a second chance at life following the first heart transplant in a woman since the state hospital's transplant programme was set up 13 years ago.

Cardiac transplants in women are rare, with more heart failure patients of transplantable age being men and this marked the first of the 35 performed by consultant cardiothoracic surgeon Alex Manchè.

"Heart disease affects four men to every woman but the situation is changing and females are catching up fast," Mr Manchè explained. The case, in fact, highlights that women too can suffer from serious heart disease. It also underlines the importance of a special device, considered by Mr Manchè to be "a bridge to transplantation".

The implantable cardioverter-defibrillator (ICD), a pacemaker that can also deliver electrical shocks to revive the heart, only started being used in Malta in the last few years, increasing the chances of survival of patients waiting for a transplant.

Mr Manchè explained that the female patient contracted a rare condition of heart failure associated with pregnancy. Her child is now three years old and the mother had been critically ill since she gave birth. But because the blood pressure in her lung circulation was initially prohibitively high, she only became a transplant candidate recently.

An ICD was implanted over two years ago by cardiac electrophysiology specialist Oscar Aquilina and the chairman of Mater Dei Hospital's cardiac unit Albert Fenech.

The device corrected the patient's high pressure and fine-tuned its rhythm, prolonging her life until a donor heart was available. It even delivered a shock, restarting the heart when it once stopped, Mr Manchè noted.

"The fact that the ICD delivered a shock in its two-year life clearly highlights that this patient would not be with us today had it not been for the device," he explained.

About one ICD a week is now being implanted at Mater Dei, meaning fewer patients die waiting for a good heart.

"It is often the case that a donor organ is not available at the time it is desperately needed but these devices can be implanted to prolong the workings of a weak heart until a suitable one is offered.

"The device is removed when the new heart is stitched in," Mr Manchè explained, listing the range available on the market, including pulsatile balloons and gas-driven pumps, apart from the special pacemaker/defibrillators.

Expensive and effective, each one is suitable in special circumstances and much research is ongoing to develop a device that serves not only as a bridge to transplantation but can also take over on a more permanent basis.

The cardiac transplant programme in Malta was founded by Mr Manchè following his experience in starting a programme at St Bartholomew's Hospital in London in 1985. "We successfully transplanted 22 patients in the first year and this gave me the impetus to start a programme here," he said.

Mater Dei's cardiac unit averages one transplant a year and it is always a major event, involving much work and worry... but also success. Ten of its 13 transplantees are alive and well and its achievements compare favourably with international figures of a seven-year survival of 65 per cent."They are living a full life and our first transplantee has enjoyed his new heart for over 13 years and is still going strong," Mr Manchè proudly reports.

"These people give me courage to continue the programme and I am particularly inspired by Alfred Debattista, our fourth transplant patient, who founded the Transplant Support Group and has done so much to promote organ donation and help patients and their families."

Malta has its own unique problems related to its small size: because donors and potential recipients are limited in number, a good match cannot always be found. In fact, it often ends up exporting some of its organs to Italy.

"It gives me great satisfaction to work with my cardiology colleagues in these challenging cases. Their input and care are vital if we are to achieve a positive outcome.

"I believe the traditional boundaries that once separated cardiologists, mostly focused on testing and medical treatment, from cardiac surgeons, who carried out the surgical treatment, are becoming blurred and we now work closer than ever to the benefit of our patients. In future, we will just have the heart doctor," he augured.

Stressing the team effort, Mr Manchè expressed appreciation for his nursing and medical colleagues and the members of the Transplant Support Group, who offer invaluable support, based on their own experiences, to the patients undergoing transplants.

"But perhaps most gratitude should go to the donor family who are so thoughtful and generous at a time of extreme crisis and sadness. My thoughts and prayers go out to them," Mr Manchè said.

"One tragedy can change the life of as many as six seriously ill people."