Howrah Team: Evolving Heart Care and Training Others 

Published March 17, 2022
Our partner Narayana Superspeciality Hospital – Howrah is the only hospital in eastern India that performs heart transplants for children. Since 2019, our medical volunteers from Children’s Minnesota have been helping its pediatric cardiac team improve results in heart surgery and post-operative care. This includes treating children born with complex heart defects and preventing post-surgery infections. The partnership is adding value in mentoring and empowering nurses who are the closest caregivers to patients and their families.
Our advanced training of the Howrah team is supported by a global health care company Abbott and through its philanthropic foundation, Abbott Fund. Its grant helps improve heart care for children at three hospitals—in the Kolkata metro area (where the Howrah hospital is located) and Bangalore.  
Cardiac surgeon Dr. Debasis Das and pediatric cardiologist Dr. Amitabha Chattopadhyay share how Children’s HeartLink helped them evolve a pediatric cardiac program.


Medical volunteers from Children’s Minnesota visiting Narayana Superspeciality Hospital – Howrah (2019)


What are the primary outcomes of a partnership with Children’s HeartLink? 

Dr. Das: It has been quite a journey since 2019 when we started collaborating with Children’s HeartLink. Our program has evolved significantly. We started our cardiac surgical transplant program in August 2020 and were the first in eastern India to perform pediatric heart transplants. We have done four heart transplants since then.

Our congenital cardiac program now handles very complex neonates and infants. The collaboration with Children’s HeartLink has added value to our program in mentoring and empowering our ICU nursing staff in a big way. In addition, the whole team’s cognizance of quality control initiatives has improved a lot. After we hired a full-time pediatric cardiac intensivist in July 2019, our surgical ICU has got streamlined significantly. The Children’s HeartLink partneship has had a positive impact on our patient planning, surgical procedures, ICU areas, and nursing skills.

Since the beginning of our cardiac surgical program in 2016, we have been doing over 500 cardiac surgeries in a year. Although in 2020 we did far less, around 300, due to the pandemic. Neonates and infants form a significant proportion of our surgical patients. (approximately 10% and 40%, respectively)

Dr. Chattopadhyay: Our pediatric cardiology program underwent a sea change in the past three years. It is related to some changes at the state level. The system of state-sponsored treatment for congenital heart disease underwent a major change, including screening and referral programs. For example, the referral base has increased, with more doctors and fellows being roped in for the peripheral clinics. The overlapping time was a bit bewildering, coupled with the debacle of the pandemic. Nevertheless, we have learned and matured more with the trying times.

Can you give one or two examples of how this collaboration helped your team and their patients?

Dr. Das: Surgical mentorship and guidance from Children’s HeartLink have helped us mature our biventricular repairs for the dTGA, VSD and PS subset of patients (a complex heart defect: transposition of the great arteries with a ventricle septal defect and pulmonary valve stenosis) . We had a clinical case of a 4-year-old girl with dTGA, VSD and PS who previously had undergone the bidirectional Glenn procedure. Her case was discussed in our joint catheterization conference with the Children’s HeartLink team during their visit in April 2019. As a result, we planned a biventricular repair (Nikaidoh procedure) and then performed it in September 2019.

Since then 12 children with the same complex defect have received biventricular repairs of all forms. These are the Nikaidoh, Rastelli, REV, and ASO with LVOT resection procedures.

Dr. Chattopadhyay: Children’s HeartLink has granted Narayana Superspeciality Hospital – Howrah quite a few free cardiovascular and diagnostics devices from Abbott. The patients who needed but couldn’t afford these devices were able to receive them. Another example is the Narayana Health system-wide training. Our hospital is part of the Narayana Health network. This program is designed to improve the understanding of the nuances of pediatric cardiology.

Can you share your own training efforts and their outcomes?

Dr. Das: Our main identified area of the problem was bloodstream infections in ICU and the subsequent mortality in neonates. With Children’s HeartLink inputs, we have been trying to address that and have been partly successful so far. Although we still have a long way to go, our nurses are much better trained in post-operative patient assessment, sterile handling of central lines, and recognition of warning signs of sepsis. The medical team does regular training sessions with our ICU nurses. Nursing leaders also teach their juniors. We have an annual detailed surgical audit and regular mortality and morbidity meetings for cardiac surgical patients.

Dr. Chattopadhyay: Children’s HeartLink helped us design several cardiology training programs for in-house fellows and students from the adjacent hospitals and states. In fact, this involves the whole nation and beyond…including the neighboring countries. The programs include didactic lectures, quizzes, case presentations, and seminars. They cover clinical aspects, echocardiography, cardiac catheterization, and general discussions.

What are your hopes for a further partnership with Children’s HeartLink?

Dr. Das: We hope to address our main issue: post-operative sepsis through this collaboration. We will seek guidance from volunteers for running a pediatric ECMO program and a transplant program, and improving our surgical outcomes. Our goal is to become a Center of Excellence in near future. (Children’s HeartLink gives this status to hospitals that achieve high-quality standards of care and commit to training their peers)

Dr. Chattopadhyay: We’re looking forward to furthering our partnership. Working with Children’s HeartLink and their volunteers has been wonderful.

Children’s HeartLink helped us critically analyze the treatment strategies and outcomes, formulate and shape the future. We’re looking forward to the whole volunteer team visiting us again. As Children’s HeartLink is closely associated with other cardiac centers spanning the whole globe, we hope that the good work done here may spread. So that one day our efforts at Narayana Superspeciality Hospital – Howrah may be recognized worldwide.

Narayana Superspeciality Hospital – Howrah is our newest partner in India. It is our second partner in West Bengal, a heavily populated state of 91 million. It is also our third partner in the Narayana Health network, along with hospitals in Bangalore (Narayana Institute of Cardiac Sciences) and Kolkata. (Rabindranath Tagore International Institute of Cardiac Sciences

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