重磅!胡盛寿院士团队将国产人工心脏在儿童体内植入

2022-06-20 中国医学科学院阜外医院 中国医学科学院阜外医院

本例手术是国内首次将植入式左心室辅助装置应用于儿童心衰患者,填补了国内在该领域的空白。

2022年6月2日,中国医学科学院阜外医院胡盛寿院士及其团队为一例高风险终末期心衰儿童成功植入Corheart 6左心室辅助装置。这是国内首例国产人工心脏在儿童体内植入的临床应用,标志着我国儿童终末期心衰外科治疗迈上新的高度,达到国际领先水平,具有划时代的里程碑意义,同时也为未来植入式左心辅助装置在儿童心衰治疗方面的应用探索打下了良好的基础。

图:胡盛寿院士(左一)

勃勃生气每况愈下

14岁,原本应该朝气蓬勃,在操场上奋力奔跑,而对于小严来说,这是想不敢想的愿望。1岁时,小严曾因先天性心脏病在当地医院完成右室双出口矫治术,术后病情得到了有效控制。本以为这一切应当随着那场手术可以回归正轨,但生活总是时不时地与他开上一场玩笑。

1年前,一场重感冒来的气势汹汹,小严当即被送往当地医院,住院期间心脏超声结果显示左室流出道狭窄,心功能减低,小严甚至感觉自己快走几步都会喘上两下。小严身体每况愈下,在一个月前,他又因胸闷气促被送到医院,心脏彩超提示心功能再次重度减低,“孩子不能再等了。去外地看看还有没有希望吧。”主治医生的每句话都重重地撞击着小严父母的心。

小严父母带他来到中国医学科学院阜外医院就诊。入院后,心脏彩超结果显示小严的心脏左室明显增大,射血分数(LVEF)为14% ,仅为正常人的三分之一,左心功能重度减轻,心功能IV级,已处于心衰终末期。雪上加霜的是,住院期间,小严的病情因左室流出道梗阻再次加重,随后转入PICU,进行气管插管后依靠呼吸机及大量药物维持整体循环。

“求求您,医生!帮我的孩子做心脏移植吧,只要他能活下来。”看着病床上,随时可能离去的孩子,小严父母无力地哀求着,但医生告诉他们心脏移植对小严来说并不适合,由于孩子极度虚弱,心脏移植后大量的抗排异和激素类药物极有可能引起严重感染。就算选择心脏移植,但儿童心脏供体非常紧缺,很可能在等待中病重甚至死亡。

人工心脏换来重生

这一切似乎都陷入一个死局。面对一个刚刚开启生命旅程的年青少年,阜外医院顶着压力,决定为其搏上一把,希望可以在技术空白中为他寻得一丝活下去的希望。

中国医学科学院阜外医院胡盛寿院士组织医院多学科专家会诊,对小严的病情进行深入研究,决定为患儿做心脏内部的畸形矫正及左心室辅助装置植入。专家们一致认为小严目前虚弱的身体无法接受心脏移植,所以植入左心室辅助装置对他来说是最好的治疗方案,一方面可以避免心脏移植后长期的药物服用,另一方面如果未来他的心功能恢复还可以撤除装置,不需要再进行心脏移植。

这是一场无章可循的手术,是国内首例植入性左心辅助装置在儿童身上的应用,再加上患儿此前还曾做过一次心脏手术,难度和风险非常高。尽管身经百战,但患儿复杂的情况,还是让胡盛寿院士和其团队成员捏了一把汗。为确保手术万无一失,术前专家们制定了详细的手术方案,充分评估术中可能面临的风险,做好一切准备。

2022年6月2日,在多学科共同努力及协助下,胡盛寿院士团队成功将Corheart6超小型磁悬浮左心辅助装置植入这位小体重患儿体内。术中,胡院士娴熟精湛的手术技巧和团队的精确配合,让手术进展十分顺利。随着辅助泵启动运行,体外循环机顺利停机撤除,患儿进入机械辅助循环模式,心率、血压等生命体征正常、平稳,手术获得成功。

“由于这位患儿心脏小,体表面积小,最终选择为他植入这枚超小型磁悬浮左心辅助装置。它的体积小,重量只有90g,能够在低转速低流量下稳定工作,同时血液兼容性更好,无溶血、血栓及其他对血液细胞的破坏等现象,对于儿童患者来说,是一个非常好的选择。”胡盛寿院士介绍,“该患儿将来很有可能恢复心功能,那么就可以撤除左室辅助装置,同时患儿也避免了心脏移植,让我们一起期待进一步的结果。第一例左心辅助儿童手术的成功,给了我们很大信心,期待未来有更多儿童心衰患者可以在阜外重获新生。”

图:Corheart 6泵体

左心辅助装置为心衰患儿争得更多希望

心力衰竭是各种心脏疾病进展至严重阶段而引起的一种复杂的临床综合征。据了解,我国每年约有40000例患儿因心衰住院治疗。根据国际心肺移植协会报道,截止2018年,全球在线注册登记儿心脏移植15264例,近10年全球儿童心脏移植数量每年均在600例左右。

目前我国儿童心脏移植主要问题是供体极度匮乏,很多儿童需要通过机械装置来等待心脏移植手术。然而国外心室辅助装置价格昂贵,国内无可用产品,桥接移植应用受限,约25%患儿在等待移植过程中死亡。本例手术是国内首次将植入式左心室辅助装置应用于儿童心衰患者,填补了国内在该领域的空白。

科技创新是一个民族进步的灵魂,是一个国家兴旺发达的不竭动力,推动医学科技创新和医学研究能力建设,是造福广大患者的重要举措。此次胡盛寿院士团队成功完成国内首例儿童左心辅助装置植入,充分体现医工合作推动国产医疗技术创新的价值。未来阜外医院还将继续探索植入式左心辅助装置在更小年龄、更小体重心衰患儿中的应用,让更多生命得以挽救。

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    2022-11-21 zblhy
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    2022-06-21 ms7000001561535422

    中国智慧,中国力量

    0

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    2022-06-21 ms7000001561535422

    大国工匠

    0

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    2022-06-22 jiyangfei
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    2022-06-22 xxxx1054
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    2022-06-21 再造人

    临时救命

    0

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    2022-06-21 毛桑

    太牛了

    0

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