核桃大小,两个鸡蛋的重量,随着这颗“全球最小人工心”的植入,张大爷的心脏恢复活力,重获新生。
近日,西安交大一附院心血管外科在麻醉手术部和超声医学科的默契配合下,顺利实施西北首例不停跳下全球体积最小、重量最轻的国产左心室辅助装置植入,是国内第六个商业化植入该产品的单位。同时西安交大一附院也成为国内第三家、西北地区首家完成全部4种国产左心室辅助装置植入的中心。
Recently, under intimate cooperation of Department of Anesthesiology and Perioperative Medicine and Department of Ultrasound Medicine, Department of Cardiovascular Surgery from the First Affiliated Hospital (FAH) of Xi'an Jiaotong University (XJTU) successfully performed beating-heart implantation of the smallest and lightest China-made left ventricular assist device, the first case of this kind in northwest China. In addition, our hospital has become the third in China and the first center in northwest China to complete the implantation of all four categories of domestic left ventricular assist devices.
“胸口像压了块石头似的,有点喘不过气。”年过7旬的张爷爷(化名)15年前就开始间断胸闷、气短,在当地医院诊断为“冠心病”。多年来,张爷爷一直被心脏疾病引起的多种不适缠身。最近半个月,他出现明显的心功能衰竭和肺部感染症状,胸闷发作加重,休息后也不能有效缓解,痛苦不堪。当地医院给予对症处理后效果不佳,为进一步治疗来到西安交大一附院心血管外科。
患者入院后,心血管外科闫炀主任立即会同李勇新、王海晨教授及重症监护室师桃主任团队,反复多次进行全面详细的评估与病情分析:患者高龄,有长期反复心衰、高血压、冠心病及糖尿病病史,EF值仅20%左右,心脏整体收缩功能差,属于终末期心衰患者。目前最有效治疗手段是心脏移植和人工心脏植入。但患者年龄大,心功能及一般状态差,心脏移植风险高,且供体紧缺,与家属充分沟通后,决定为患者植入目前全球体积最小、质量最轻的左心室辅助装置——Corheart® 6。
After the male patient, surnamed Zhang, was admitted to our hospital, Director Yan Yang from Department of Cardiovascular Surgery, Professor Li Yongxin, Professor Wang Haichen and Director Shi Tao’s team from ICU repeatedly evaluated and analyzed his physical conditions. The elderly male patient had a long-term history of recurrent heart failure, hypertension, coronary heart disease and diabetes mellitus, EF value was only about 20%, and the overall systolic function of heart was poor. He was diagnosed with end-stage heart failure. At present, the most effective treatments are heart transplantation and artificial heart implantation. However, considering his age, poor heart function and basic conditions, the risk of heart transplantation is high. Donor shortage was another challenge. After in-depth communication with his family members, it was determined to implant Corheart® 6 in this patient, which is the smallest and lightest left ventricular assist device worldwide.
Preoperative CTA showed extensive calcification and stenosis in the neck vessels, ascending aorta, aortic arch, descending aorta and bilateral femoral arteries, occlusion of the left subclavian artery, and severe stenosis of the right iliac artery. There was limited space in the ascending aorta for vascular anastomosis.
On September 12, after preoperative preparations, the team from Department of Cardiovascular Surgery performed the implantation surgery for this patient with intimate cooperation from Department of Anesthesiology and Perioperative Medicine, Department of Ultrasound Medicine, cardiopulmonary bypass team and ICU from Department of Cardiovascular Surgery. The team avoided calcified vessels, selected the right radial artery and left femoral artery for invasive blood pressure monitoring, and chose the right axillary artery-internal jugular vein-femoral vein intubation for cardiopulmonary bypass. With normal operation of blood pump, the patient's vital signs tended to stabilize, and the implantation of left ventricular assist device was successfully completed. Postoperatively, the patient was transferred to ICU from Department of Cardiovascular Surgery for intimate monitoring and treatment. At present, the patient has been transferred to general ward.
The left ventricular assist device is an important device for treating end-stage heart failure. The domestic left ventricular assist device of Corheart® 6 implanted in this patient is a third-generation non-contact magnetic levitation centrifugal pump. The diameter of the blood pump is merely 34 mm, weighed approximately 90 g, which is 40% smaller and 50% lighter compared with the same products. It is the smallest and lightest implantable full magnetic levitation artificial heart worldwide, especially suitable for end-stage heart failure patients with small cardiac chamber, low body weight and minimally invasive implantation. Moreover, small device size and intraoperative incision can mitigate surgical trauma. Besides, the longest battery life can reach up to 33 h. The external controller, battery and other components, which have to be worn for a long time after surgery, only weigh 800 g, which significantly reduces the burden and improves postoperative quality of life of the patients.
截止目前,西安交大一附院心血管外科针对不同类型、年龄、体重的患者,已完成所有四种适用于不同人群的国产人工心植入手术,真正实现了精准化、个体化、规范化的诊疗服务,在我国终末期心衰外科治疗领域具有丰富的先进经验和强大的综合实力。相信随着医疗技术的不断进步和创新,我们能为更多的终末期心衰患者带来更优质、高效的医疗服务,让他们重获健康。