[Behind the 10-year life extension of the artificial heart? Take you to know about the artificial heart! 】
Moderator: Ding Ling (Liaoning Provincial Science and Technology Museum)
When the heart fails to beat, an artificial heart/left ventricular assist device (LVAD) can last for 10 years? From thoracotomy to minimally invasive implantation, the treatment of end-stage heart failure in China has ushered in a breakthrough moment – the latest clinical data of Fuwai Hospital is revealed: which patients can regain their vitality with it?
Today, we will continue to invite Professor Chen Sijiao, a cardiovascular and cerebrovascular expert from the First Hospital of China Medical University: Unveil the mystery of LVAD!
Moderator: Haosheng Yuan (China Medical University)
Artificial heart between life and death: behind the 85% survival rate, who is suitable for LVAD implantation?
End-stage heart failure ≠ despair! A list of life-saving options after the approval of the Chinese version of the HeartMate 3
From 20% to 60% 5-year survival rate: How does an artificial heart rewrite the outcome of “cardiac death”?
Thoracotomy Implantation vs Minimally Invasive Access: Where has the “Chinese Solution” for Artificial Heart Come?
Cardiac Surgeon’s Note: Why Did I Fit My Heart Failure Father With an Artificial Heart?
International Breakthrough Case: The “Medical Miracle” of the Few:
USA: In 2019, a patient implanted with HeartMate 3™ completed a half marathon (21 km) under the supervision of a team of physicians, and cardiac function returned to NYHA Class I 3 years after surgery.
Japan: In 2021, it was reported that an LVAD implanter participated in a 10-kilometer charity run, carrying spare batteries and monitoring equipment throughout the race.
Left ventricular assist device (LVAD) science: from life support to future prospects
1. What is LVAD?
A left ventricular assist device (LVAD) is an implanted mechanical pump that pumps blood throughout the body by replacing or assisting a failing left ventricle for long-term life support in patients with end-stage heart failure or bridging treatment prior to heart transplantation.
Core technology: Modern LVADs (such as the HeartMate 3) use magnetic levitation technology to avoid friction of mechanical bearings, significantly reducing the risk of blood clots and hemolysis.
Applicable scenarios: When there is a shortage of heart transplant donors, LVAD can replace cardiac function for a long time (target treatment); or buying time for people waiting for a transplant (bridging treatment).
2.LVAD的适应症与禁忌症
(1) Indications (meet any of the following conditions)
End-stage heart failure: refractory to medical therapy, cardiac function grade NYHA class IV or INTERMACS class 2-4.
Heart transplant transition: Expect to wait more than 6 months for a donor.
Patients who are not transplantable: are not candidates for heart transplantation due to age or comorbidities and require long-term support.
(2) Contraindications
Severe right heart failure: The right ventricle does not provide enough blood to the LVAD.
Irreversible organ damage: such as end-stage liver and kidney failure, irreversible brain damage.
Active infection or bleeding: risk may be exacerbated by postoperative anticoagulation.
Inadequate psychological or social support: the patient is unable to cooperate with long-term management.
3. China’s first LVAD implantation: current situation and significance
Hospital and team: Both expressions of “China’s first case” are valid:
(1) The first case of scientific research: In 2020, Wang Chunsheng’s team completed the implementation of this technology for the first time on behalf of China.
Patient status: The patient survived for more than 3 years after surgery, the quality of life improved significantly, and regular follow-up showed that the device was functioning normally.
Breakthrough significance: It marks that China’s end-stage heart failure treatment has entered the era of “total artificial heart”, and promotes the research and development of domestic LVAD (such as “Yongrenxin” pump).
(2) The first clinical case: the first standardized clinical application after the approval of Hu Shengshou’s team representative in 2024.
The latest generation of full magnetic levitation left ventricular assist device HeartMate 3™ has been implanted for the first time in the country in Fuwai Hospital! The cumulative number of implants worldwide has exceeded 35,000.
A 71-year-old male patient was diagnosed with dilated cardiomyopathy, cardiac function grade IV (INTERMACS grade 3), moderate to severe mitral valve regurgitation, persistent atrial fibrillation, etc., and advanced heart failure. Symptoms of heart failure began to appear 14 years ago, and after standardized oral drugs for heart failure and implantable cardioverter-defibrillator (ICD) implantation, heart function continued to deteriorate, and acute heart failure worsened in the past 1 month, and he was hospitalized in the intensive care unit (ICU) of the Department of Cardiology of Fuwai Hospital, Chinese Academy of Medical Sciences. At present, he has severe cardiac dysfunction, left ventricular ejection fraction (LVEF) is only 20%, and his condition is stable after adjustment of cardiology ICU treatment before surgery, and the team evaluates that he meets the indications for left ventricular assist device (LVAD) implantation, and there are no contraindications, so he underwent HeartMate 3™ implantable left ventricular assist system surgery.
4. The world’s first LVAD: history and current situation
1966: The world’s first LVAD (Liotta-Cooley device) implantation was completed at Methodist Hospital in Houston, USA, and the patient survived for 4 days after surgery.
Milestone significance: Despite the low early survival rate, it ushered in a new era of mechanical circulatory support.
Modern comparison: The 5-year survival rate for current LVADs (e.g., HeartMate 3) is 58% (2019 MOMENTUM 3 trial), with the longest survival rate exceeding 10 years.
5. Survival rate and patient status
(1) Global data: As of 2023, there have been more than 30,000 cases of LVAD implantation in the world, with a 1-year survival rate of 85% and a 5-year survival rate of 50-60%.
(2) Progress in China: Nearly 100 cases of LVAD implantation have been carried out in China, and the one-year survival rate is close to the international level (about 80%).
(3) Survivor life: Most patients can resume light physical activities (such as walking, housework), and need to carry an external controller every day and regularly monitor anticoagulation.
Early data (2010-2018, mainly imported equipment):
The average survival time is 3-4 years, and the longest survival case is 7 years (Fuwai Hospital, implanted with HeartMate II in 2015). HeartMate 3™ (latest generation LVAD):
Clinical trial data: 5-year survival rate of 58% to 65% in the MOMENTUM 3 trial;
Longest survival case: Individual patients have been reported to survive for more than 12 years (ongoing follow-up) in the United States.
Historic models (e.g., HeartMate II): Documented maximum survival of 10 years and 6 months (as a lifelong treatment)
6. Future outlook
(1) Technological innovation
Miniaturization and cordlessness: Development of LVADs that can be fully implanted into the chest cavity and free from the constraints of external wires.
Intelligent early warning system: real-time monitoring of pump speed and flow rate through AI, predicting the risk of thrombosis or failure.
(2) Bioengineering breakthroughs
Tissue Engineering Blood Vessels: Reduces complications of artificial materials coming into contact with blood.
Stem cell combination therapy: promotes myocardial repair, and some patients may be removed from LVAD support.
and (3) China’s development goals
Localized substitution: reduce equipment costs (imported LVAD is about 80-1 million yuan), and it is expected that domestic pumps will account for more than 50% in 2030.
Establish a national collaboration network: standardize the qualifications of implant centers and train multidisciplinary teams (cardiac surgery, critical care, rehabilitation).
epilogue
From “prolonging life” to “restarting life”, LVAD is rewriting the fate of end-stage heart failure. With the advancement of technology and the improvement of the medical system, more patients will benefit from this “artificial heart” in the future, realizing the leap from survival to high-quality survival.
Scientific data:
1.Jorde UP, Saeed O, Koehl D, et al. The Society of Thoracic Surgeons Intermacs 2023 Annual Report: Focus on Magnetically Levitated Devices. Ann Thorac Surg. 2024; 117(1):33-44. doi:10.1016/j.athoracsur.2023.11.004.
2.Bourque K, Cotter C, Dague C, et al. Design Rationale and Preclinical Evaluation of the HeartMate 3 Left Ventricular Assist System for Hemocompatibility. ASAIO journal (American Society for Artificial Internal Organs :1992). 2016; 62(4):375-383.
3.Mehra MR, et al. Aspirin and Hemocompatibility Events With a Left Ventricular Assist Device in Advanced Heart Failure: The ARIES-HM3 Randomized Clinical Trial. JAMA. 2023 Dec 12; 330(22):2171-2181. doi: 10.1001/jama.2023.23204.PMID:37950897; PMCID: PMC10640705
Dear friends, have you learned today? We’ll see you tomorrow!
This article is only for health science popularization and is not a substitute for diagnosis and treatment. If you have any symptoms, please go to a regular medical institution immediately.
Co-production: Popular Science Liaoning-Science Popularization Base of the First Hospital of China Medical University
This article was written by Yuan Haosheng, China Medical University
Chen Sijiao, First Hospital of China Medical University
Liaoning Provincial Science and Technology Museum Ding Ling
Review: Chen Sijiao, First Hospital of China Medical University/Liaoning University for the Elderly
General Drawing: CMU Science Park Medical Student Team
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Original title: “Medical Voice| China Medical University said popular science: when the heart can’t beat, a “LVAD” can last for 10 years? 》
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