She is 54 years old and has an artificial heart
Grocery shopping, walking, chatting with friends about parents, 54-year-old Wu Li (pseudonym) seems to have no different life than ever. It's just that she has a small black bag around her waist, which contains batteries and hope - she is the first domestic ultra-light artificial heart clinical trial in South China.
On March 29, the reporter met Wu Li at the Guangdong Provincial People's Hospital for a review. She has a rosy complexion, full of breath, and walks freely. It is hard to imagine that more than a month ago, she wandered in front of the "ghost door" because of her heart failure, and once worried that she would not be able to survive.
"Technological advances have provided new attempts for patients with end-stage heart failure, and artificial hearts are the future development trend." Huang Jinsong, deputy director of the Department of Cardiac Surgery of Guangdong Provincial People's Hospital, although happy to see scientific and technological progress, still holds a cautious attitude: "Before the end of clinical trials, it cannot be said that it is absolutely safe and effective. ”
Artificial heart surgery site.
Heart transplant "closed the door" on her, artificial heart "open window"
Wu Li felt "wrong" a year ago.
At first, after walking around a little longer, she would feel tight in her chest and panting, and her heart would beat very fast. But sit back and relax, and these discomforts can be relieved. But within half a year, her chest tightness and shortness of breath began to worsen, always coughing up white foamy phlegm, and her legs would be unexplained edema.
She told her nursing daughter about these symptoms, and her daughter took her from her hometown in Shantou to Guangzhou to see a doctor. Wu Min, deputy chief physician of the Heart Transplantation and Ventricular Auxiliary Surgery Department of Guangdong Provincial People's Hospital, immediately arranged for her admission and further improved the examination.
Wu Li's condition was even more serious than she had imagined—dilated cardiomyopathy had caused her to enlarge her whole heart, severe tricuspid valves to regurgitate ventricular cuspical thrombosis, and moderate pulmonary hypertension. This means that her heart can hardly beat itself, and her heart failure is at the end of its life.
Heart transplantation is one of the few treatments for patients with end-stage heart failure. However, the test results once again gave Wu Li a "sunny thunderbolt" - the preoperative examination found that there were antibodies in her body, which would lead to rejection after heart transplantation, which was a contraindication to heart transplantation. Do you have to give up? The Wu Li family felt desperate.
At this time, a clinical trial for patients with end-stage heart failure was undergoing a multi-center study in China, and the Guangdong Provincial People's Hospital was one of the hospitals participating in the trial. However, clinical trials are ultimately risky and require the full informed consent of patients and families to proceed. This trial is a new option for heart failure treatment that Wu Li has never heard of - artificial heart.
The difficulty and ease of the "heart of steel"
When she heard that she could try an artificial heart transplant, Wu Li's heart was mixed with joy and worry.
Happy to have new options, maybe able to return to life; worrying about the effect and safety, as well as the quality of life after surgery. "I also read the information on the Internet, and many people have controllers and batteries as big as small school bags, and I am a little frightened." Wu Li told the doctor about the doubts in her heart, and when she learned that the battery was now as small as a mobile phone, and the controller could also be put into a small satchel, she put her mind at ease.
In the end, Wu Li and her family agreed to "give it a go". "Before making a decision, we are more anxious after thinking about it, but we still believe in doctors and believe in technology." Wu Li's husband said that the moment he saw his wife being pushed into the operating room, his heart was fixed, "As long as there is hope, you must try." ”
In the operating room, the organ transplant team led by Huang Jinsong is carrying out the operation in an orderly manner. Compared with heart transplantation, the difficulty of artificial heart transplantation is to maintain the balance of blood flow in the heart.
The artificial heart used by Wu Li is not an all-artificial heart made of machinery, but a "pump" the size of an adult's thumb, which is mainly used to replace the heart's blood pumping function. In a normal heart, the blood produced in the left ventricle enters the ascending aorta as the heart expands and contracts, thus entering the human blood circulation. Wu Li's heart could no longer beat vigorously, so blood was backlogged in the heart. The main role of the artificial heart is to draw blood out of the left ventricle and then hit the ascending aorta.
To achieve this function, a powerful pump and an artificial blood vessel are required. The artificial heart used in Wu Li's surgery weighed only 90 grams, which is currently the smallest and lightest artificial heart. The doctor made a small opening under her left heart, docked with the artificial heart, connected the artificial heart to the artificial blood vessel, and finally sutured the artificial blood vessel with the ascending aorta.
The most critical moment in surgery is when the artificial heart and artificial blood vessels are connected to the heart. At this time, the patient's own heart, cardiopulmonary bypass machine, and artificial heart are working at the same time, and the blood flow must reach a delicate balance. If the left heart blood is drawn more, the right heart will increase the blood return, which may cause the left ventricle to have no blood to draw.
Luckily, Woolly's surgery went well. When she woke up in the ICU, she saw the battery placed outside her body and sighed: "I am alive, and I will rely on it to help me in the future." ”
Wu Li's post-operative recovery was quick, and within a week, she was able to stand on her own. Compared to heart transplantation, artificial hearts have unique advantages – patients do not have to take anti-rejection drugs, there is no rejection reaction, just take anticoagulant drugs and review them regularly.
Huang Jinsong, deputy director of the Department of Cardiac Surgery of Guangdong Provincial People's Hospital.
"Now the technology has been so developed"
More than a month after the operation, Wu Li felt that she had come back to life. Previously, because of her heart failure, she felt difficult lying flat in bed. Now, breathing heavily and walking on her own again, her life is slowly back on track.
After returning home from the hospital, many of Wu Li's friends came to visit her. Learning that she used an artificial heart, my friends felt very curious: "Now the technology has been so developed!" There are also friends who are more concerned about her life: "Carrying batteries every day, how to bathe and sleep?" Can I still go through security when I travel? ”
Ma Danying, a heart transplant and auxiliary surgery nurse at Guangdong Provincial People's Hospital, told Wu Li one by one before she was discharged from the hospital. There are a total of 6 external batteries, and only 2 cells need to be used at a time to support 8 hours of power. The other battery, then replace the use after charging. There is a special waterproof bag when bathing, which does not affect the use.
But if she had to go through security, Wu Li would have to show the security officer an information sheet to prove that she was using an artificial heart. Her contact information is also left on the information sheet, which can facilitate her to ask for help in the event of a problem outside.
For many years in the front line of heart transplantation, Huang Jinsong has witnessed the development of artificial heart. He introduced that at present, artificial heart is mainly used in three clinical aspects: one is to wait for transitional support before heart transplantation, to win more time for heart failure patients to wait for a suitable donor; the other is to provide short-term alternative support for patients with acute heart failure, and to avoid heart transplantation after the heart function is restored; the third is to provide long-term replacement for heart failure patients, so that patients can carry artificial hearts for long-term survival.
"Nowadays, the third case is increasingly used." Huang Jinsong said that the United States has statistics that among patients who carry artificial hearts for a long time, the longest has survived for more than a decade. But on the mainland, such practices are still in their infancy.
Although artificial hearts can benefit many patients, there are also certain risks. Huang Jinsong introduced that a typical artificial heart system consists of four parts: blood pump, drive device, monitoring system and energy. According to the principle of blood pump, blood pump can be divided into pulsation pump, axial flow pump and centrifugal pump.
As the first generation of artificial heart, the pulsation pump shoots blood at a fixed frequency and has little damage to the blood. However, it is larger and has a shorter service life. The axial flow pump is a second-generation artificial heart, which is small in size and small in murmur, but the speed is too high to easily destroy the blood component, resulting in hemolysis. The third-generation centrifugal pump used by Wu Li has good durability, little damage to blood, little murmur, and can also reduce thrombosis. However, the centrifugal pump must maintain the speed of the machine to maintain the state of magnetic levitation, otherwise the function will be affected.
"From clinical trials to product launches, there is still a long way to go. It provides a choice, but it also needs to be verified. Huang Jinsong said that the most important thing for patients with heart failure is early detection and early treatment, even if it is the use of artificial heart, it is also necessary to evaluate the original heart function of patients. At present, the artificial heart is mainly used for ventricular assistance, and the all-artificial heart that can replace the whole heart is still under development and improvement.
[Reporter] Zhu Xiaofeng
【Photography/Videography】Luo Yifei
【Editing】He Zhihao
[Correspondent] Jin Ting Zhang Lanxi
【Author】 Zhu Xiaofeng; Luo Yifei; He Zhihao
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