These blood volumes are equivalent to the workload of a normal and healthy heart-the heart is a muscle pump, which pumps blood returning from veins to the aorta and then supplies it to organs all over the body.
This is also a few days before February 28th, 20021year. Patients with end-stage heart failure pump out about 4 times the amount of bleeding per minute every week. At that time, his heart was like an inelastic ball and almost stopped working.
When the emergency doctor of the Second Hospital of Zhejiang University saw Zhou Zhou in the emergency room of the hospital on the evening of February 22nd, the patient's heart beat very fast, and his blood pressure was extremely low-the heart that had no strength to pump blood out was trying to increase the beating frequency.
If Zhou was sent to the Second Hospital of Zhejiang University a week earlier, his fate would be the same as that of other patients with end-stage heart failure in China. If he can't be the lucky one in 600-700 heart transplants every year, his heart will stop beating.
One week before admission, the Second Hospital of Zhejiang University decided to start the artificial heart project and began to look for the first patient suitable for artificial heart implantation.
The heart, which has always been a symbol of life, carries a deeper emotional color than other organs of the human body.
But in the eyes of surgeons and scientists, it is just an elaborate "blood pump". When the heart fails seriously, the only way is to have a heart transplant-but there are only about 5,000 heart donors for nearly 26 million patients with heart failure every year in the world.
Since the 20th century, the birth of artificial heart has perfectly filled the shortage of heart donors. In the United States, 20 13, the number of patients receiving artificial heart implantation has exceeded that of patients receiving heart transplantation. This mature technology in the world was officially approved in China on 20 19-only a few dozen patients in China had undergone artificial heart implantation through clinical trials before the week.
Dong Aiqiang, who has seen countless deaths of patients with end-stage heart failure, explained "artificial heart" to Zhou Huiming's eldest daughter as popularly as possible. She has never heard so many medical terms in her first half of her life.
Implanting a machine to replace the work of the left heart is scary to think about. But when she heard the doctor say that "my father's heart may stop beating at any time", she lost her fear of her father and gradually overcame her fear of artificial heart.
In the end, Hui Zhou made the most difficult decision in her life. With the trust accumulated in the conversation with Dong Aiqiang, she said to Dong Aiqiang, "I gave my father to you."
A few days ago, Zhou Du passed the critical period and moved out of the ICU ward. He has been a farmer all his life and has not fully understood how much his "heart" has changed. All along, the driving force that prompted him to decide on surgery and try to survive was that "his two daughters are willing to spend so much money to save him."
Today, the beating artificial heart in Zhou is somewhat different from Dong Aiqiang's experience of artificial heart when he visited the Berlin Heart Center more than ten years ago.
It beats mechanically, but it is not cold.
A failed heart.
Dong Aiqiang remembers that when he was sent to the emergency room of our hospital, Zhou's heart beat very fast, reaching 120- 130 beats per minute; Blood pressure is very low, and the contractility of the heart is very weak-it can only be compensated by speeding up the frequency.
Dilated cardiomyopathy significantly enlarged his left ventricle. When the heart relaxes, the diameter of the normal left ventricle is about 4.5 to 5 cm, and the diameter of the peripheral left ventricle has reached 8.5 cm, which is almost twice that of the normal heart and 8 times that of the normal heart.
The most terrible thing is that his heart, like a "ball" with declining elasticity, has failed.
In the eyes of surgeons, the heart is just a blood pump. It keeps working year after year, pumping out more than 7,000 liters of blood every day, flowing through nearly 654.38+10,000 kilometers of blood vessels.
The more blood the heart discharges in each contraction, the stronger its function. Ejection fraction is a technical term, which is used to judge the pumping function of the heart and is also an important index to evaluate the degree of heart failure in clinic. Zhou's ejection fraction is only 14%, which can generally be understood as: when his heart relaxes, if the left ventricular volume is 100ml, the volume is 86ml when he contracts, and only 14ml of blood is pumped when he contracts.
The EF value of 14% is less than that of normal people. In patients who need heart transplantation, the EF value is often much higher than that of weeks.
Echocardiography showed that his mitral and tricuspid valves had a lot of reflux.
Mitral valve and tricuspid valve are one-way valves connecting left and right ventricles and atrium respectively. In the blood circulation of human body, blood flows from the right atrium to the right ventricle at the first stop, and then enters the pulmonary circulation for aerobic exchange. Oxygen and good blood enter the left atrium and left ventricle in turn, and finally the left ventricle pumps blood to the whole body.
The whole process is one-way and irreversible. If mitral and tricuspid valves regurgitate a lot, that is to say, the doors of ventricle and atrium can't be closed, the heart does a lot of useless work.
There were dilated cardiomyopathy, mitral and tricuspid regurgitation and moderate to severe pulmonary hypertension.
My daughter Hui Zhou's little knowledge of these technical terms made her realize that her father's heart was "bad". Before the operation, during the cardiac CT examination, the contrast agent needs to be injected, and the contrast agent will flow into the heart, but after the father injects the contrast agent, it cannot flow into the heart.
That day, CT didn't come out. She was trembling with fear. A person's blood cannot flow. How serious is her heart disease?
A restless father
The whole body is 1.73 meters high and has a typical peasant face. He is thin and dark all the year round. In Taizhou, Zhejiang, he has a Gua Tian, which has planted watermelons for more than ten years.
I have lived for most of my life, and I am strong and seldom get sick. I like to work when I am busy. Even if it rains, I will go to Gua Tian with a hoe.
Hui Zhou couldn't tell when his father first fell ill. From the doctor's inquiry, she recalled that there were many typhoons in Zhejiang in the summer of 20 17. After catching a cold in the rain, her father began to have symptoms of heart disease.
The common manifestation of heart disease is decreased activity endurance. It is effortless to walk three or four floors and four or five floors at ordinary times. But when my father is sick, walking on the first and second floors will lead to asthma and need to rest.
Even today, the starting point of heart injury is still inconclusive. Dong Aiqiang speculated that it might be pneumonia caused by catching a cold in the summer of 20 17, which induced Zhou Yuan's existing myocardial injury problem.
During the acute attack of heart failure, Zhou felt chest tightness and shortness of breath, and could not eat. When he lies down, he can feel that kind of suffocating feeling, as if someone had pinched your neck.
But after treatment, these symptoms disappeared quickly, so the family didn't take it seriously. Father may be too tired. Just have a rest. Hui Zhou always thought so.
But what she didn't expect was that many acute heart failure became chronic refractory heart failure. Basic diseases, such as colds and hypertension, may induce chronic heart failure to turn into acute heart failure.
The mortality rate of heart failure is very high. According to foreign statistics, the overall 5-year survival rate of patients with heart failure receiving drug treatment is about 35%, and the 5-year survival rate of patients with end-stage heart failure is only 20%. Once cardiogenic shock occurs, the one-year survival rate drops to 1 1%.
Knowing that her father had a heart attack, Hui Zhou refused to let him do manual labor again, and her mother was in poor health. In order to take care of her parents, her family of four moved back to Taizhou where their parents lived. But my father, who has been busy all his life, is idle at home every day, which is too uncomfortable. He found a job as a security guard himself.
In the next two or three years, the heart failure recurred, and the hospitalization frequency became higher and higher, but the treatment effect became worse and worse.
The most dangerous one happened after 202 1 Spring Festival. One day after leaving the local hospital in Taizhou, Zhou suffered from heart failure again. On the night of being hospitalized again, the doctor asked Hui Zhou if he wanted to be hospitalized. If he moves in now, he may never go back.
It was the first time that she realized that the problem was so serious. My father was ill for three years, but Hui Zhou always knew little about his illness. She always thought that her father's symptoms were chronic and related to his good mood.
It was not until she was transferred to the Second Hospital of Zhejiang University that the doctor explained to her that she knew that her father was in the late stage of heart disease, and his heart could not beat and his blood could not flow, which had affected other organs.
A common sense in the medical field is that if the heart function is not good, the liver and kidney function will also be bad. The heart is a dynamic organ. If the heart is not good, it will lead to congestion, and all organs of the whole body will be damaged: liver congestion, cirrhosis, hepatosplenomegaly; Intestinal congestion, affecting absorption, loss of appetite; Blood stasis in lower limbs, blood can't go back, legs and feet are swollen.
All the above symptoms have appeared every week. When admitted to the hospital, the liver and kidney function were incomplete, and he could not eat anything, and his lower limbs were severely edema.
But this is what Zhou understood after his father became a patient with end-stage heart failure.
Never-ending artificial heart
Zhou's clinical diagnosis soon came out: dilated cardiomyopathy, end-stage heart failure, accompanied by cardiogenic shock, massive mitral and tricuspid regurgitation, moderate and severe pulmonary hypertension.
Behind these terms, there is only one judgment: the only effective treatment for this patient is heart transplantation.
Heart donors have always been a scarce resource. In China100000 heart failure patients, less than half of them can live for five years. Among them, among 1 10,000 patients with advanced heart failure, only 600-700 people wait for the heart donor to complete the heart transplant every year.
Zhou's condition is very urgent, so it is impossible to wait for the donor, and pulmonary hypertension is a relative contraindication for heart transplantation. "He is suitable for artificial heart implantation." Dong Aiqiang's team quickly made this judgment.
Actually, the concept of artificial heart is not "advanced". For many years, in addition to donor hearts, scientists have been looking for the possibility of replacing natural organs with artificial organs, and gradually evolved from in vitro to in vivo.
Originally known as "artificial heart", it is a device equivalent to extracorporeal circulation machine, which replaces the heart to exercise the function of blood circulation in heart surgery. Later, artificial liver (MARS), artificial heart and lung (extracorporeal membrane oxygenation and ventilator) and artificial kidney (CRRT) were all in vitro devices, but they could only temporarily replace the functions of human organs.
These extracorporeal devices are complex and huge, and can only be operated by professionals during surgery or used as life support equipment in intensive care unit.
To implant an artificial heart in the body, miniaturization is necessary. The artificial heart implanted in the body weighs 400 grams, and only about 200 grams have been produced at present-all manufacturers are looking for products that make the artificial heart smaller, lighter and more in line with the human body.
On the other hand, the conditions for clinical application are gradually maturing.
Dong Aiqiang introduced that the landmark event of clinical application of artificial heart dates back to 200 1 year, and the New England Journal of Medicine published a semi-final research result. Patients with end-stage heart failure were randomly divided into two groups, one group was treated with artificial heart and the other group was treated with drugs. The results showed that the survival curve of artificial heart group was much higher than that of drug treatment group. With the development of evidence-based medicine, the clinical application of artificial heart has finally seen a bright future.
Subsequently, thousands of cases of artificial heart implantation abroad every year have been widely recognized by the medical community.
The artificial heart to be used in the Second Affiliated Hospital of Zhejiang University is produced by a company in Chongqing. The company started clinical trials in June 20 18, and was officially listed in September 20 19. Its design is not complicated: a silver "pimple" made of peptide alloy is the core of the whole instrument, weighing about 400g and the size of a fist. It consists of upper blood pump chamber and lower motor assembly, which are connected by liquid bearing and mechanical shaft seal. Driven by the motor, the blades of the blood pump will run at a uniform speed.
During the operation, the artificial heart will be placed in the abdominal cavity under the patient's heart by the surgeon.
In a series of operations by surgeons, artificial heart can replace the failed left ventricle and become the power source of pumping blood to the whole body. Therefore, it has a more accurate name: left ventricular assist device.
Before the domestic clinical trials, the artificial heart products of that company in Chongqing had obtained sales licenses in Japan and Europe, obtained clinical trial exemption (IDE) in the United States, and completed more than 200 implantation operations.
However, in China, this technology is still very early. Before it is officially listed, it can only be applied to a small number of patients through clinical trials and humanitarian exemptions. Since the official launch of 20 19, only three implantation operations have been completed.
The Second Hospital of Zhejiang University officially decided to start the clinical application project of artificial heart after the 20021Spring Festival holiday. Wang Jianan, secretary of the Party Committee of the Second Hospital of Zhejiang University, director of the Heart Center and a famous cardiovascular expert in China, is a staunch promoter of the artificial heart project. He not only thinks that artificial heart implantation is an important part of the discipline of building the peak of heart in the Second Hospital of Zhejiang University, but also thinks that artificial heart implantation is the most solid step to treat patients with end-stage heart disease, a worldwide problem of heart failure.
20021February 16 On the fifth day of the first month, at 8: 00 on the first day of work, the Second Hospital of Zhejiang University held a kick-off meeting for the clinical application project of artificial heart. All functional departments come to prepare for the upcoming artificial heart implantation, including filing, price and ethics, which is very complicated.
Having been a doctor for many years, Dong Aiqiang has seen too many patients with end-stage heart failure who can't wait for the donor and lose hope. More than ten years ago, when he visited the National Heart Center in Berlin, Germany, he was deeply impressed by the artificial heart. After more than ten years of development, the safety and effectiveness of artificial heart have been verified abroad. However, due to various reasons, this life-saving device has never become a life-saving straw for patients with advanced heart failure in China.
From that day on, Dong Aiqiang began to look forward to the first patient suitable for artificial heart implantation.
Six days later, Zhou was admitted to the hospital.
Schematic diagram of artificial heart operation
The main component of artificial heart
The hardest choice of my life.
19 March, the first day after the operation 19, Hui Zhou put on protective clothing for the first time and walked into the cardiovascular intensive care unit. At 9 o'clock in the morning, just after rounds, my father finished simple bedside activities and went back to bed.
He looks fine without a hospital gown and a tube all over his body.
Father has lost a lot of weight. Just after extubation, he only eats one or two spoonfuls of liquid food at a time. But that morning, he drank a whole bowl of porridge, and such an ordinary news was enough to make Hui Zhou "extremely happy."
After the operation, Hui Zhou visited his father in the intensive care unit for the first time.
Looking at his recovering father, Hui Zhou is still a little scared. If he hadn't come to the Second Hospital of Zhejiang University, "I might not have a father".
Compared with hundreds of thousands of patients who die of heart failure every year, Zhou's family is lucky.
Hui Zhou still remembers Director Dong Aijiang's first conversation with her about artificial heart. When he mentioned that an artificial heart might be their last hope, her first reaction was, "Take your heart off and put it in a new machine. This is terrible. "
Of course, this is not the case. Artificial heart implantation is different from heart transplantation, and it is not necessary to remove the patient's original heart. However, the "implantable" artificial heart still needs to be powered by an external battery that you carry with you. She checked online, and the controller outside the body is like the "battery" of a battery car, and with all the external equipment, it weighs almost 3 kilograms.
The fact that she will never leave the power supply is terrible. It has been hovering in her mind and turned into countless lingering questions: What if there is no motivation? What if the battery is broken?
What should I do when I take a shower?
The pipe connecting the artificial heart passes through the abdominal cavity of the patient, about 3 meters long, made of stable waterproof material and connected to the controller.
You can put the controller outside the bathroom when you take a shower. Dong Aijiang answered Hui Zhou's questions. She still hesitates. At the initial moment, the lucky attitude prevailed. "Maybe we can match the donors?" She thought.
This conversation has been going on many times. Dong Aiqiang introduced the advantages and disadvantages of artificial heart to Hui Zhou as popularly as possible: after implantation, foreign bodies will produce thrombus in the blood and need to take anticoagulant drugs for a long time; It needs to be recharged every 8- 10 hours, which requires patients and their families to really accept the implanted heart and maintain its operation.
Dong Aiqiang is also frank, this is the first artificial heart implantation operation in the hospital, and the hospital has also taken great risks.
Zhou's condition deteriorated within a few days of admission.
Hui Zhou heard the worst news. His father's heart could stop beating at any moment. On February 26th, she made "the hardest decision of her life". After a sleepless night, she called Dong Aiqiang: "I want to seize this opportunity. This is my father's last chance. I gave my dad to you. "
After deciding to have the operation, Hui Zhou called his father. His father said on the phone, "You two sisters are willing to pay for me. No matter how hard I try, I will grit my teeth and fight for it. "
Come back like Iron Man.
It has been two days since Hui Zhou made a decision and arranged the operation.
The operation was performed on February 28th. Compared with the difficult choices before operation and the complicated management after operation, the operation itself is not that difficult.
For a surgeon like Dong Aiqiang who has been in medicine for more than 20 years, this is not a very difficult operation: routine thoracotomy to establish cardiopulmonary bypass, separation of a capsule next to the heart, artificial heart, repair mitral and tricuspid regurgitation, and then implantation of artificial heart.
In all operations, turning on the controller switch of artificial heart is the most ceremonial. The number on the monitor is finally adjusted to 18 10 rpm, which means that the blades of the artificial heart rotate at a speed of about 18 10 rpm. Under normal circumstances, this rotation speed means that about 4-6 liters of blood are pumped out every minute, which is equivalent to the blood pumped out every minute when a healthy heart works.
After the switch is pressed, the artificial heart completely replaces the blood supply function of the heart.
Zhou's own heart is still beating. But listen carefully, there is a faint hum in his abdominal cavity, which is the sound of artificial heart vibration.
From 8 am to 6 pm, Hui Zhou and his family waited outside the operating room for 10 hours, which was only the first level.
After artificial heart implantation, the symptoms of peripheral heart failure disappeared quickly, but new problems appeared again. The never-ending artificial heart breaks the balance between the left and right heart: the failure of the left heart also affects the right heart.
After artificial heart implantation, the blood pumped out increased, and the blood returned increased accordingly, which was unbearable for the right heart at once.
It takes time to establish a new balance between the left and right hearts.
After the operation, the monitoring team assisted the right heart for a period of time through the auxiliary equipment in the monitoring room. Finally, the right heart seems to have adapted to the new pumping capacity.
Three weeks later, my father finally passed the critical period and transferred from the intensive care unit to the general ward. This is the moment when Hui Zhou finally began to sleep peacefully since his father was admitted to the hospital for more than half a month. From then on, she no longer had to worry about emergency calls from day or night.
The cost of an artificial heart is not low, 8.9 million. Plus the cost of surgery and hospitalization, the economic cost is almost millions. She is a working family, which is not a small sum, but almost all her savings.
Before the operation, Hui Zhou asked Dong Aiqiang how long his father would live if all went well. Dong Aiqiang told her that there have been 10 years abroad. "I thought to myself, even for five years, I am willing." She said.
Previously, Hui Zhou was worried that after his father was discharged from the hospital, he would always live with a battery like a "tail" and be stared at by others. Will he feel inferior?
This problem once troubled Hui Zhou, but now, seeing her father's gradually recovering spirit, she began to think that his two grandchildren must be the happiest on the day when his father came home from the hospital.
Perhaps in their hearts, grandpa, like Iron Man, came back from a robbery and became extremely powerful.
"This is so cool. Grandpa will be their superhero. " Hui Zhou is full of hope for the future.
Note: At the request of the interviewee, Zhou and Zhou Hui are both pseudonyms.
Written by Zhu Xueqi
Editor-in-Chief Wang Chen
This article was first published in the "Eight Tips" (ID: Health Insight) of WeChat official account.
Respect the original copyright, please do not reprint it without authorization.