A Nashville Transplant Story
By MELANIE KILGORE-HILL
Babu Helps Rebuild Saint Thomas Heart Transplant Program
A love of tinkering can set a curious mind on an unexpected path. Such was the case for Ashok Babu, MD, cardiothoracic surgeon and surgical director of the Saint Thomas Health heart transplant program. In 2016, the Illinois native arrived in Nashville to re-launch the hospital's transplant program, now 42 hearts strong.
"I had an engineering mind and was always interested in taking things apart and fixing them," Babu said. "When I got old enough, I really enjoyed working on cars and would fix the family car ... sometimes with disastrous consequences. I really learned a lot from doing that."
While Babu went on to major in engineering at Chicago's Northwestern University, medicine was in the back of his mind thanks in part to his physician uncle. "I liked the idea of medicine and working with patients and their families, and I had a lot of interest in medical devices," he said. "Cardiac surgery interested me early on, and I had a combined interest in heart and lungs which really aren't dissimilar from car engines. The heart and lungs are mechanical in many ways, and that appealed to me."
In 2002, Babu received his medical degree from Northwestern University and went on to complete general and cardiothoracic surgery residencies at the University of Colorado in Denver. He remained on staff at the University of Colorado Hospital, specializing in adult cardiac surgery, mechanical circulatory support, and heart transplantation.
An encounter with a Saint Thomas surgeon at a national conference peaked Babu's interest in the health system's once thriving heart transplant program, now in need of a reboot. Saint Thomas West Hospital, a pioneering site for heart transplantation in Tennessee, closed its program at the end of 2011 but was looking to re-launch the specialty.
"I was really impressed with the excellent surgeons and people I'd be working with and was enticed by the opportunity to restart a program and mold it in a way that's best for the patient," Babu said. "The whole team - from the nurses to the OR staff - were just great people, and we liked Nashville."
Upon arrival, Babu worked alongside cardiac surgeon David Glassford, MD, who performed the state's first heart transplant at Saint Thomas Hospital in 1985. Eighteen months later, the program is in full swing with Babu at the helm.
"This is a team effort; it's not just one surgeon or cardiologist," Babu said. "Patients are treated by a surgeon and one of our five heart failure cardiologists who can determine when it's time for more advanced therapies."
While heart transplant is the ultimate treatment for end stage heart failure, advances in short- and long-term support devices like ECMO are offering more hope to patients who previously had little. Extracorporeal membrane oxygenation drains the blood from the vein, adds oxygen and removes carbon dioxide while warming the blood and pumping it through the body. This method allows the blood to "bypass" the heart and lungs, encouraging them to rest and heal.
"The ECMO is a miniature heart-lung machine and can support the body till the heart gets better or we can fix it," said Babu, noting that most patients use the ECMO between 10-14 days.
Another option - the left ventricular assist device, or LVAD - is a mechanical pump implanted inside a person's chest to help a weakened heart pump blood. Babu said many elderly patients with end stage heart failure who are not candidates for heart transplant could now live for years with good quality of life thanks to advances in LVAD technology.
Not surprisingly, technological breakthroughs have also created a shift in allocation of donor hearts. "The current paradigm for many patients is they get an LVAD, go home and come back for a heart," Babu said. "Now heart allocation guidelines are being revised to favor hospitalized patients who may need LVAD, but we want to try to get them the heart instead."
Babu looks forward to growing Saint Thomas's mechanical support programs through ECMO, temporary and durable LVAD, and total artificial heart (TAH), reserved for patients with both right and left failed ventricles who are not candidates for LVAD.
"There's never been a great device for this population, who may end up on ECMO with no other hope besides heart transplant," Babu said of the SynCardia TAH, which will be available at Saint Thomas Heart later in 2018.
"We want to make the community aware of these devices because you can go to small hospitals around the region and people may not know they exist," he said. "Our job is to educate other physicians and nurses about these technologies so they can educate their patients and refer them to us in a timely manner. We have a full heart failure program and provide every therapy available to this challenging population."