World’s 3rd Case: “Heart + Aortic Arch” Combined Transplantation

Local News. On March 26, Mr. Li was successfully treated by a "heart + aortic arch" combined transplantation which is the world's third case and the first miracle in China's main land. To celebrate the new birth, Mr. Li and his medical staff jointly planted a "heart tree" on the square lawn of Renmin Hospital of Wuhan University.

The heart is the "engine" of the human body, and the aorta is the "main pipe" of blood vessels. The importance of both is self-evident. But Mr. Li suffers from dilated cardiomyopathy, aortic sinus aneurysm and Marfan's syndrome. The "engine" and "main pipe" could stop at any time. Half a month ago, Professor Wang Zhiwei, director of cardiovascular surgery at Renmin Hospital of Wuhan University, spent 7 hours to successfully implement the combined transplantation of heart plus ascending aorta, aortic arch and partial descending aorta, which saved Mr. Li's life.

According to literature search, this technique has not been reported in mainland of China before, and only two cases have been reported worldwide. In 2012, Zhenxing General Hospital of Taiwan reported a case of a patient with Marfan syndrome who underwent heart transplantation combined with partial artificial vessel replacement of ascending aorta, total arch and descending aorta at the same time. In 2016, the Affiliated Hospital of the University of Pennsylvania reported a case of heart transplantation with reconstruction of aortic arch.

Mr. Li is a thirty-eight farmer in Yulin City ofShanxi Province. Since 2016,he has shortness of breath after activities. Last June, the symptoms of shortness of breath became worse, and he also had chest pain and chest tightness, unable to lie flat at night, and edema in both lower limbs. He went to many big hospitals in Shanxi, Beijing and other places for medical treatment, but failed to get effective treatment. Doctors in Beijing recommended him to professor Wang Zhiwei, director of cardiovascular surgery at RenminHospital of Wuhan University.

Wang Zhiwei introduced that Mr. Li's condition was extremely complicated. First of all, he had a severe dilated cardiomyopathy: whereas a normal heart is about the size of a fist, Mr Li's heart has expanded to the size of four fists, taking up almost the entire chest cavity, while suffering from heart failure. In addition, his aorta, which transports blood, was severely enlarged: normal people were only 2-3 centimeters tall, while his was up to 8 centimeters tall. Generally, when the diameter of aorta is more than 5 cm, the risk of rupture is very high, and once the rupture, there is no chance of rescue.

To save lives, the heart and aorta must be replaced at the same time. Wang Zhiwei said that heart transplantation and aortic simultaneous transplantation are extremely rare, and the operation is complex and difficult. Surgeons need both excellent heart transplantation technology and surgical skills for cardiovascular diseases. According to various medical literatures, only two cases of "heart + aorta" combined transplantation have been reported in the world, which is slightly different from Mr Li's condition. Professor wang zhiwei, who is accustomed to challenge the routine and dare to innovate, decided to take another risk for the patient's life. The cardiovascular surgical team developed a rigorous treatment plan: first, conventional heart transplantation was performed under cardiopulmonary bypass; then, deep hypothermia and circulatory arrest techniques were used to cut off the blood supply of the whole body, and rapid aortic arch transplantation was carried out.

Everything is ready, only owe to the East Wind. Fortunately, Mr. Li was hospitalized for only one week and waited for the successful matching of organ donors. In the early morning of March 13, this significant transplantation operation began.

At 5 a.m., Mr. Li was escorted to the operating room. Professor Zhan Liying's team of anesthesia department carefully escorted him to anesthesia. Professor Wang Zhiwei's team first underwent heart transplantation. With the cooperation of extracorporeal circulation technology, Mr. Li's heart stopped beating, and the blood supply of the whole body was borne by the cardiopulmonary bypass machine. Professor Wang Zhiwei's team took 70 minutes to quickly remove the almost ineffective original heart, implant a healthy heart, and closely suture the main blood vessels.

After heart transplantation, the more dangerous and difficult combination of ascending aorta, aortic arch and descending aorta is performed. Wang zhiwei introduces, aorta this "main conduit" once stop, the blood of the blood of major viscera of the head and whole body stops immediately, the important organ of ischemia anoxia can enter exhaustion condition very quickly. At this point, we must race against time.

Under the careful operation of the medical staff, the whole body blood of the patient enters the artificial cardiopulmonary machine for oxygenation and cooling, and the blood is cooled from about 37 degrees to 25 degrees in depth. This temperature can prolong the tolerance time of organs to ischemia, and minimize the irreversible damage of organs caused by ischemia and hypoxia.

When the patient's breathing and heartbeat stopped, Professor Wang Zhiwei's team took 19 minutes to complete the transplantation of ascending aorta and aortic arch. Usually, the procedure takes 30 minutes.

The key to success or failure of the operation is whether the heart can regain beating after transplantation in patients with deep hypothermia and circulatory arrest. Medical staff re-transported blood to patients and gradually warmed up to 37 degrees. With the new heart slowly returning to pulsation, blood began to circulate spontaneously again in the body, and everyone on the operating table breathed a sigh of relief.

After 7 hours of operation, at about 12 noon, Mr. Li returned to the ward safely. Less than 24 hours later, he recovered from a coma and pulled out his ventilator at 6:00 on the 14th. At 8 a.m. on the 14th, Mr. Li, who was lying in bed and knew that he had succeeded in the operation, held Professor Wang Zhiwei's hand tightly and shed tears. At 12 noon on the 14th, he began to eat on his own.

After the operation, Mr. Li recovered quickly. After pulling out all kinds of drainage tubes one by one, he began to walk independently. Looking at the cherry blossoms blooming outside the ward, Mr. Li couldn't restrain the joy of rebirth. He expressed his desire to go out and have a look to Cai Xin, head nurse of cardiac surgery .

In order to satisfy his wish, on March 26, the hospital held a special love activity for Mr. Li: "Doctors and patients grow trees at the same time". Tang Qizhu, Vice President of Wuhan University and Dean of People's Hospital, accompanied Mr. Li to enjoy cherry blossoms in the hospital, and planted a cherry tree on the lawn in front of the hospital.

After soil cultivation and watering, Mr. Li personally put the nameplate "Rebirth of Li Yanshan, Shanxi Province, 2019.3.13" on the "heart-growing tree" . He said that he had two wishes. One was to come back to Wuhan in the second half of the year to participate in the second "heart-changing games" of Renmin Hospital of Wuhan University and to visit the World Military Games held in Wuhan. Another is to come to Wuhan every spring to appreciate cherries, take care of the "heart-growing tree" planted by himself, and expect to see more people hang the "new" nameplate on the branches.

(Transferred by Ren Wei)

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