On October 11, a multidisciplinary cardiac intensive care team from Qilu Hospital of Shandong University successfully implanted an "artificial heart", that is, left ventricular assist device, into a patient with dilated cardiomyopathy combined with severe heart failure. This is the first permanent "artificial heart" implantation completed by Qilu Hospital of Shandong University, and it is also the first left ventricular assist device implantation led by the Department of Cardiology in China. On November 8, the patient recovered and was discharged from the hospital.
The patient was 52 years old and had a history of dilated cardiomyopathy for more than 10 years. 6 years ago, the patient's left ventricular ejection fraction had decreased to 0.3 (normal value >0.5), combined with frequent multi-source ventricular premature and short-onset ventricular tachycardia, which was not getting better after improving ventricular remodeling and taking antiarrhythmic drugs. 2 years ago, the patient had a severer symptom of chest tightness and shortness of breath, accompanied by frequent ventricular tachycardia, which required electrical cardioversion. 1 year ago, the patient was implanted with an implantable cardioverter defibrillator (ICD). In the past six months, the patient's chest tightness and shortness of breath worsened, and he was unable to take care of himself, or lie down at night. Any light activity may induce heart failure and ventricular tachycardia, so he came to Qilu Hospital and local hospital for many times. Recently, he came to Qilu Hospital again for his severer heart failure cannot be alleviated. Despite adequate drug treatment, the patient's left ventricular ejection fraction was only 0.13, which means his heart function failed to meet the his body's metabolic needs at rest. Therefore, Academician Zhang Yun suggested that the patient undergo heart transplantation or left ventricular assist device implantation. Finally, after repeated argumentation and under the consent of the patient’s family, the team adopted the treatment plan of left ventricular assist system, that is, "artificial heart" implantation for the patient.
Academician Zhang Yun is doing bedside echocardiography for the patient before surgery
In order to ensure that the "artificial heart" implantation surgery is infallible, the Department of Cardiology organized an MDT consultation and preoperative evaluation with the Department of Cardiovascular Surgery, NICU, Echocardiography Room of the Department of Cardiology, Department of Anesthesiology, Operating Room, Department of Infectious Diseases, Department of Pulmonary and Critical Care Medicine, Department of Hepatology, Department of Endocrinology, and ICU, etc. After comprehensive and systematic evaluation, experts unanimously agreed that this patient was at the end stage of heart failure and sudden death could happen to him at any time, so artificial heart implantation was an appropriate and feasible treatment. In addition, experts had a fully discussion on possible intraoperative and postoperative complications and their management options.
Department of Cardiology organized an MDT meeting before the surgery
On the morning of October 11, the patient entered the operating room. For a patient with such severe heart failure, anesthesia and cardiopulmonary bypass is very dangerous. In order to monitor the hemodynamic changes of the patient, Qi Feng, Director of the Department of Anesthesiology led his team to establish a series of invasive monitoring system for the patients’ blood pressure, central venous pressure and pulmonary artery pressure, etc. They carried out general anesthesia for the patient, which made full preparation for the coming surgery.
Professor Zhang Xiquan’s team is cooperating in left ventricular assist device implantation surgery
Chen Yuguo, President of Qilu Hospital, directed personally during the surgery, and Professor Zhang Xiquan, Director of the Department of Cardiovascular Surgery, led his team worked closely with Professor Dai Xiaofu’s team from the Department of Cardiac surgery of the Fujian Medical University Union Hospital. They made a hole in the left ventricular apex, inserted the catheter of the "artificial heart" into the left ventricle and sutured around it, and then perforated the ascending aorta and anastomosed with the catheter of the "artificial heart". This new and delicate operation was carried out smoothly under our skilled surgeons. During the operation, Academician Zhang Yun led the echocardiography team to use transesophageal ultrasound technology to monitor the left and right ventricular function, the size of each cardiac chamber, pulmonary artery pressure and other cardiac indexes in real time. With the close cooperation of surgeons, anesthesiologists and cardiopulmonary bypass surgeons, the patient gradually separated from cardiopulmonary bypass, and his heart slowly returned to beat. ECG monitor showed that his heart rate and blood pressure were normal, and transesophageal ultrasound showed that his left and right ventricles contracted well, which means it is time to turn on the "artificial heart".
"Turn it on!" With the order of the surgeon, the "artificial heart", which is like a "blood pump", was officially in operation. Surgeons constantly adjusted the rotational speed of the "artificial heart" to ensure the smooth improvement of hemodynamic parameters combining with the position of interventricular septum, valve opening range and left and right ventricular function shown by the ultrasound. Finally, with the assistance of the "artificial heart", the left ventricular pump volume of the patient reached the needs of the normal human body, the patient's blood pressure, heart rate, respiration and cardiac ultrasound parameters all met the surgical requirements, and the implantation of left ventricular assist device was declared a success.
Academician Zhang Yun, Professor Zhang Cheng and Associate Professor Liu Yan are doing transesophageal echocardiography during the operation
Despite the successful implantation of left ventricular assist device, the patient still faced a series of life difficulties, of which the most serious complications are bleeding, right heart failure and infection, so postoperative monitoring and treatment are very important. After the patient returned to the intensive care unit, the cardiovascular surgery and cardiology teams closely monitored the operation of the "artificial heart", fluid, left and right ventricular function, thoracic drainage and blood coagulation. The tracheal intubation was pulled out on the third day after operation, and the patient could breathe on his own well. After a series of standardized treatments including strict fluid management, improvement of right ventricular function, prevention of ventricular remodeling, prevention of infection, etc., the vital signs of the patient were gradually stabilized, and then the patient was transferred to the general ward. He got out of bed on his own, and carried out rehabilitation treatment. On November 8, he was discharged from the hospital.
Academician Zhang Yun said that heart failure is the end stage of all kinds of heart diseases, and the 5-year mortality rate can reach 50%. In China, nearly 1 million patients need heart transplantation every year, but due to the lack of donors, only more than 600 patients receive heart transplantation every year. In this case, the implantable left ventricular assist device undoubtedly brings hope to patients with end-stage heart failure.
The "artificial heart" is made of pure titanium and weighs 420 grams. Its core component is a metal blood pump like a water pipe tee. When it works, it assists or replaces the pumping function of the human heart like the turbine of a washing machine.
The successful implantation of the first left ventricular assist device in Qilu Hospital marks the formal establishment of a multidisciplinary artificial heart team and indicates that Qilu Hospital is a world leader in the field of end-stage heart disease treatment. It also marks that China's domestic cardiac medical equipment has risen to a new level. Under the guidance of the spirit of the 20th CPC National Congress and under the leadership of Academician Zhang Yun and Professor Zhang Cheng, the cardiovascular team of Qilu Hospital will work together to guard people’s health.
