“I couldn’t believe I had two hearts in my chest.” That’s how Lincoln Paiva, urbanism researcher and doctoral candidate at Mackenzie University, describes the first moments after an unprecedented procedure that involved two hearts working in his body, then undergoing another surgery that would leave him with only one healthy organ.
To have these two hearts in his chest, Paiva faced a long journey. It all started in February 2020, when he had a heart attack that left his heart very weak.
“The way you are here, you can only last three more months”, was what he heard from a doctor at the time, he says.
In this situation, it was necessary to join the heart transplant queue — something that in itself takes a long time. According to Fábio Gaiotto, cardiovascular surgeon at Incor (Institute of the Heart) of the Hospital das ClÃnicas at USP and responsible for the development of the new technique, Brazil performs an average of 380 transplants per year, but it would be necessary to do between 2,000 and 2,500 to supply all the demand.
In June 2021, still awaiting the transplant, he had to be hospitalized due to the critical condition he had reached.
Already hospitalized, Paiva was constantly undergoing tests to monitor his health. In one of these routine procedures, another complication was discovered: her pulmonary pressure was too high, a consequence of the infarction.
This circumstance makes the heart weaker, which decreases its ability to drain blood from the lungs. Thereafter, the lung accumulates an exaggerated amount of blood, causing the pulmonary pressure to rise.
Gaiotto explains that pulmonary hypertension makes transplanting a new heart unfeasible because “the patient is likely to die in the surgery [ou em alguns meses] “.
“When it’s very difficult for the blood to leave and enter the lungs, if this resistance is too high, you can see that the right side is suffering. If I put in a new heart, it won’t work because it comes from a healthy person. The left side adapts very quickly, but the right doesn’t”, says Gaiotto.
Normally, a patient with this diagnosis would need an artificial ventricle, equipment that acts like a mechanical heart. It would function as the left side of the organ and reduce pulmonary pressure to enable the transplant to be carried out, says Gaiotto.
The price of this equipment, however, is approximately R$ 800 thousand, which makes access to this alternative in Brazil difficult.
Without the mechanical heart, Paiva would have only a few months to live and would probably be referred to palliative care. Gaiotto says that, at Incor alone, there are three to four patients a month in this situation.
To get around this clinical picture, the surgeon researched on heterotopic heart transplantation, a procedure in which two hearts are implanted in the patient. According to him, this technique has been used since the 1970s, but it is not suitable for people with high pulmonary pressure.
“[Colocar dois corações, seguindo a técnica antiga,] It does not work [para quem tem hipertensão pulmonar] because, between six months or a year, the sick die, as the old heart is still inside and at some point it stops working, [desenvolvendo] clot and infections,” he explains.
Thus, he realized that it would be necessary to make adjustments to the procedure. “What I thought was to change the two-heart surgery so that the new heart mimics [um coração artificial], because we’ve learned that with a mechanical heart, after three to six months, the pressure in the lung can drop.”
So, for the idea to materialize, a first surgery was needed to implant a healthy heart in Paiva. That way he got two hearts.
Gaiotto also developed a model in which “all the blood that comes from the head and arms would pass through the new heart, enter the old one and go straight to the lungs”.
This strategy was necessary because the surgeon wanted to preserve the normally more fragile right side of the new heart so that he could later work alone on the patient’s chest.
After the first surgery, Paiva remained hospitalized at Incor to monitor how his body adapted to the two organs. “I felt like I had two hearts because they beat in different syncs, but at first my body had difficulty understanding,” he says.
In Gaiotto’s planning, the patient would have both hearts for two to three months. It was expected that, in the meantime, the pulmonary pressure would decrease and it would then be possible to do a second surgery—to remove both hearts and then put in just the new, healthy heart to function like an ordinary heart.
As expected, the pulmonary pressure did show signs of falling, but the sick heart stopped sooner than planned. Therefore, the second surgery was brought forward to be performed 45 days after the first. Despite the scare, in the end, both procedures worked.
Currently, Paiva lives with only one heart, the one that is new and that is still healthy. He is in the process of recovery, but he is already seeing an improvement in his quality of life.
“He has a 70% to 80% chance of remaining alive in 15 years. In 20 years, the chance is 40% to 50%, which is the survival of a heart transplant”, explains Gaiotto.
At the moment, three other patients are being evaluated as candidates to undergo the two surgeries, but Gaiotto emphasizes that this is an exceptional procedure and that it can only be done when there are no other possibilities.
“The procedure we are proposing does not compete with the mechanical heart, which does the work on the left side, because it is the best option and has more indications, but it is still very expensive”, he concludes.
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