Recently, with multi-department cooperation from Department of Anesthesiology and Perioperative Medicine, Department of Ultrasound Medicine and other departments, Professor Yan Yang's team from Department of Cardiovascular Surgery adopted minimally invasive approach to successfully perform "mitral valvuloplasty combined with artificial heart implantation" for a patient with end-stage heart failure. This adult patient with heart failure weighed 35kg, the lightest weight case of LVAD implantation in China. This revolutionary surgery resolved two disorders simultaneously, which is the first case of this kind in China.
The female patient, surnamed Li, was diagnosed with dilated cardiomyopathy 6 years ago. Three years ago, she underwent implantation of cardiac resynchronization therapy with defibrillator (CRT-D) due to repeated shortness of breath, fatigue and other symptoms. In recent 6 months, her disease condition was significantly worsened. Echocardiography showed that the left heart was enlarged, more than twice the size of normal population, complicated with severe mitral regurgitation, and the EF value was only 15%, less than one third of normal value. She sought for further treatment in the First Affiliated Hospital of Xi’an Jiaotong University (XJTU).
The critically ill patient only weighed 35 kg. Hence, it was challenging to find a matching heart donor in a short period of time. Regarding such complicated condition, Department of Cardiovascular Surgery organized multidisciplinary team (MDT) consultation and preoperative evaluation with experts from Department of Cardiology, Department of Ultrasound Medicine and Department of Blood Transfusion to minimize surgical risk and trauma. After MDT consultation, Director Yan Yang from Department of Cardiovascular Surgery proposed a minimally invasive surgical regimen of "simultaneous mitral valvuloplasty combined with artificial heart implantation", and delivered explicit surgical procedures and emergency measures.
On the afternoon of March 15, Professor Yan Yang, as the chief surgeon, cooperated with medical staff from Department of Anesthesiology and Perioperative Medicine, Department of Ultrasound Medicine and other departments to successfully perform minimally invasive "mitral valvuloplasty in combination with LVAD implantation" via the third intercostal space on the right side and the fifth intercostal space on the left side. The entire surgery endured for nearly 4 h. The right chest incision was only 4cm, and the left chest incision was 7cm. Intraoperative esophageal ultrasound indicated that the position of LVAD was appropriate, the heart valve function was normal, and no reflux was observed. She successfully received the weaning from ventilator and further rehabilitation therapy.
In this case, the third-generation extracorporeal magnetically-levitated artificial heart was implanted. The "core" blood pump is merely47 mm in diameter and 186 g in weight, which is small and convenient to carry. It can partially or completely replace the left ventricular pumping function.
