The 76 year old man with terminal heart disease has undergone two heart operations, and has repeatedly passed the god of death. Now he is reborn. This is a miracle of life brought by an Artificial heart. "I seem to have won the lottery! Now I can finally sleep soundly." On May 26, 18 years after coronary artery bypass surgery, Zhang Daye (not his real name), a 76 year old patient with end-stage heart disease, was successfully implanted with a Artificial heart in the Cardiovascular Surgery Department of the First Affiliated Hospital of Xi’an Jiaotong University, and was reborn.

76 years old, do you want to implant Artificial heart?

Grandpa Zhang (pseudonym), who is 76 years old, is a patient with end-stage ischemic cardiomyopathy. 18 years ago, he was diagnosed with "coronary heart disease" and underwent coronary artery bypass surgery with four implanted bridging vessels. In the past six months, there has been a serious decline in activity tolerance, with sweating and panting all over the body within 50 meters, and inability to sleep all night. After nearly half a month of treatment in the local hospital, the symptoms were still not relieved. Under the introduction of an acquaintance, he came to the Cardiovascular Surgery Department of the First Affiliated Hospital of Xi’an Jiaotong University.

"The patient’s myocardium was severely damaged. The Ejection fraction of the heart was only 28%, which was 1/3 of that of the normal person. At the same time, there was a large amount of mitral regurgitation, which belonged to severe heart failure." After the patient was admitted to the hospital, Guo Fengwei, the deputy chief physician, improved various examinations such as color Doppler echocardiography, cardiography and ECT. At the same time, vasoactive drugs and Diuretic should be used to adjust the patient’s heart function, which had poor effect. According to the research and judgment of the medical team, Artificial heart implantation is the only hope for Grandpa Zhang’s survival.

At the age of 76, the risk of Artificial heart implantation doubled. After surgical coronary artery bypass grafting, adhesions may form in both the mediastinum and chest cavity. If a conventional median thoracotomy is used, it is likely to damage the bridging vessels with unobstructed blood flow, further exacerbating cardiac function damage. The elderly’s heart function is already very poor, and they may not be able to withstand the impact of a second thoracotomy. How to complete surgery with minimal trauma? How to avoid damaging the bridging vessels during surgery? The medical team is facing numerous problems.

Birth, aging, illness, and death are normal. I used to be a soldier and had participated in wars. Even if the gun was stuck in my forehead, I was not afraid. I know I am old and the risk of surgery is high, but I believe you all are willing to gamble. Perhaps it was his past experience that gave him courage, "Grandpa Zhang firmly said to his chief doctor, Professor Yan, with a longing for life in his eyes

Creating a New Path for Minimally Invasive "Pump Replacement to Save Heart"

Normally, the inlet vessel of the left ventricular assist device (Artificial heart) is connected to the heart tip of the patient, and the outlet vessel is anastomosed to the Ascending aorta. However, since the patient had undergone coronary artery bypass grafting 18 years ago, and the four bridging vessels were all anastomosed on the Ascending aorta, there was no enough space for the anastomosis of the outflow vessels of the Artificial heart. After comprehensive consideration, Yan Yang’s team decided to break away from the routine and adopt a minimally invasive approach without thoracotomy. The left ventricular assist device was implanted through the fifth intercostal approach of the left sternum, and the outflow vessel was anastomosed to the descending aorta to treat the patient’s "heart" disease with minimal trauma and the optimal surgical strategy.

It is understood that the traditional Artificial heart implantation surgery requires two incisions to anastomose the inlet and outlet vessels. Now, if the outlet vessels are anastomosed on the descending aorta, only one incision is needed to complete the anastomosis. The innovation of this surgical method can not only effectively simplify the surgical procedures, reduce the Surgical incision, reduce the surgical trauma, but also bring personalized and accurate treatment programs to patients while ensuring the surgical efficacy.

With the tacit cooperation of the Anesthesia and Surgery Department, Ultrasound Medicine Department, Extracorporeal Circulation Department, and other departments, Yan Yang’s team established peripheral extracorporeal circulation assistance through femoral artery and venous catheterization. Using esophageal ultrasound to accurately locate the left ventricular apex, free and suspend the pericardium to expose the left ventricular apex, and successfully completed the left ventricular assist device implantation surgery. With the digital adjustment on the controller of the Artificial heart, the blood pump carrying the hope successfully ran at the set speed, and the operation was successfully completed.

Breaking the shackles of age, the future of Artificial heart is expected

After the surgery, Grandpa Zhang was sent to the extracardiac ICU for rehabilitation treatment. With the careful treatment and care of the medical team in the intensive care unit, he was transferred back to the regular ward in just 5 days. Nowadays, Grandpa Zhang’s heart function has significantly improved. He can often be seen walking with a battery on his back in the ward, and his appetite is much better than before.

I didn’t expect the medical technology to be so advanced now. It’s a miracle that I can live so spiritually! Thank you to all the medical staff of the cardiac surgery department. "One month after the surgery, Grandpa Zhang bid farewell to the medical staff of the cardiac surgery department with great energy, and was discharged and returned home. Speaking of his plans for his future life, he looked at his wife who had been with him for more than 40 years with a smile and said, "When I was young, I followed the army around and didn’t have time to accompany you. When we got better, we went out for a walk together, got together with the children more, and enjoyed this hard-earned day.

"There is no clear age limit for Artificial heart, but each patient’s individual situation is different. We will make a comprehensive assessment based on the patient’s physical condition, surgical risks and potential benefits, and study the feasibility and effect of the operation. If the operation is beneficial to the patient and I am willing to accept the operation, then even the older patients have the opportunity to accept the Artificial heart implantation operation. The continuous progress of medical technology and Innovation has brought tremendous breakthroughs to the medical field. The emergence of Artificial heart not only provides new options for those patients waiting for Heart transplantation, but also brings hope for those patients who cannot accept transplantation surgery temporarily. The 76 year old man has successfully implanted a Artificial heart, so that more elderly patients with end-stage heart failure can see the miracle of medicine, and we are full of expectations for future medical development. " Yan Yang, Director of Cardiovascular Surgery Department of the First Affiliated Hospital of Xi’an Jiaotong University. At this stage, Artificial heart is listed as a national restricted technology due to the high difficulty of its implantation process, the complexity of postoperative management, and the high requirements for the technical level of operators. At present, only a few well-known large comprehensive tertiary hospitals in China can carry out it. Since the First Affiliated Hospital of Xi’an Jiaotong University carried out Artificial heart surgery in April 2022, 24 cases of Artificial heart implantation have been successfully completed, with an annual survival rate of more than 90%. It is the most implanted and experienced surgical treatment center for end-stage heart failure in northwest China, and the first "Left Ventricular Assisted Implantation Technology Teaching Center" in northwest China. In the future, the team will continue to make every effort to fully leverage the leading and exemplary role of the "National Team" for the surgical treatment of heart failure at the First Affiliated Hospital, and contribute to the construction of a healthy China and a national regional medical center.

This article is reprinted from "Dingxiangyuan"

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