On May 9, the first patient undergoing "artificial heart" implantation in northwest China was discharged after postoperative recovery. He was surnamed Wang from Chongqing. On April 12, he developed advanced heart failure and was sent to the First Affiliated Hospital of Xi'an Jiaotong University (XJTU) by ambulance, and was rescued by VA-ECMO via the axillary-femoral arteriovenous bypass. Soon after, an artificial heart was implanted and multi-valve replacement and repair were completed simultaneously. A series of surgical procedures were independently completed by the team led by Professor Yan Yang from Department of Cardiovascular Surgery.
The 53-year-old patient underwent coronary intervention for acute myocardial infarction 11 years ago. In the past two years, he began to present with symptoms such as chest tightness, shortness of breath, edema of bilateral lower limbs, making him unable to lie down at night. He was diagnosed with "end-stage heart disease, heart failure, and grade III-IV heart function". The patient sought for medical assistance in many hospitals, whereas these symptoms were not significantly improved. Heart transplantation might be the last solution.
On the evening of April 7, the patient was transferred to our hospital for emergency treatment due to acute heart failure. In the early morning of April 8, his condition was aggravated. He developed cardiogenic shock, blood pressure declined to 70/40mmHg, unconsciousness, and his life was in danger. After emergency consultation, Professor Yan Yang’ team from Department of Cardiovascular Surgery urgently performed VA-ECMO implantation via the axillary-femoral arteriovenous bypass to temporarily stabilize the patient's vital signs. Next, heart transplantation may be the final procedure to save his life. However, it is widely understood that the chance of heart transplantation is extremely low due to the shortage of donor organs. In addition, ECMO can be maintained only for a certain period of time. Why not choose artificial heart implantation rather than wait for the “unpredictable outcome”? The suggestions given by Professor Yan Yang were accepted by the family relatives.
At 9: 00 a.m. on April 12, Professor Yan Yang, in charge of the surgery, along with intimate cooperation from Department of Anesthesiology and Perioperative Medicine, Cardiac Ultrasound Room and other departments, successfully completed the first case of artificial heart implantation+aortic valve replacement+mitral and tricuspid valve plasty under VA-ECMO usingaxillary-femoral arteriovenous bypass in northwest China. The operation lasted for nearly 5 h, and hemodynamic monitoring showed that the function and relevant parameters of the patient's "compound" heart were gradually stabilized. Postoperatively, the patient had a steadily-beating rechargeable artificial heart.
After the surgery, the patient was transferred to ICU of Department of Cardiac Surgery for monitoring and treatment. With the joint efforts of patient and medical staff, he successfully survived the critical period. On April 27, the patient was transferred from ICU to general ward for subsequent rehabilitation therapy.
At 27 d after operation, after attentive treatment and care of medical staff from Department of Cardiac Surgery, the patient was fully recovered and discharged from hospital. On the same day, Department of Cardiac Surgery successfully completed the second case of artificial heart implantation. "The second patient was diagnosed with acute myocardial infarction and sudden cardiogenic shock after PCI, more challenging than the first case", said Director Yan Yang. The patient is currently recovering in ICU of Department of Cardiac Surgery, and physical condition is generally stable.
