On January 10, a 53-year-old patient with end-stage heart failure underwent a heart transplant at Union Hospital through an intercostal space between the ribs. The world's first thoracoscopic-assisted right anterolateral small-incision heart transplant was successfully performed.
In 2014, the patient, Ms. Wu, was diagnosed with dilated cardiomyopathy, complicated by malignant arrhythmia, pulmonary arterial hypertension, hypoproteinemia, and severe malnutrition. Before surgery, she weighed only 45 kilograms. She sought treatment at the Department of Cardiovascular Surgery at Union Hospital.
After consulting with the patient, Prof. Dong Nianguo, Director of the Department of Cardiovascular Surgery, organized multiple multidisciplinary consultations. Following a systematic evaluation of the patient’s condition, the team concluded that heart transplantation was the only effective treatment available. However, the patient would be unable to withstand conventional open-chest surgery. Using imaging technology to reconstruct the internal anatomy of the patient's thoracic cavity, Professor Dong's team developed comprehensive contingency plans and ultimately decided to perform a thoracoscopic-assisted minimally invasive heart transplant. During the procedure, surgeons made an incision measuring only 8 centimeters in the intercostal space on the patient's right side and used a retractor to spread the ribs, creating a circular "window" about the size of a fist. Through this access, the diseased heart was carefully removed, the donor heart was implanted, and five critical anastomoses were precisely sutured, namely the left atrium, pulmonary artery, aorta, inferior vena cava, and superior vena cava. After 61 minutes of cardiac blood flow interruption, the donor heart resumed strong, rhythmic beating inside the patient's chest.
Four days after surgery, the patient had already begun bedside rehabilitation. She was able to get out of bed, eat, and walk, regaining independence in basic daily activities.
"At present, the internationally recognized and widely adopted approach to heart transplantation involves opening the chest through a median sternotomy, fully exposing the heart within the surgical field to complete the transplant," Prof. Dong explained. "The advantage of this traditional technique lies in the ample operating space and clear visibility, and decades of accumulated clinical experience have made it mature and safe. However, for patients, it causes significant trauma, leaves a surgical incision measuring 20 to 25 centimeters, compromises the integrity of the thoracic cage, and requires a prolonged recovery period." Due to the complexity of heart transplantation and the unique characteristics of human anatomy, the procedure has long been regarded as the "last fortress" yet to be conquered by minimally invasive surgery, an area his team has continuously explored. "This innovative technique preserves the integrity of the thoracic cage to the greatest extent possible and is suitable for most heart transplant recipients. In particular, it offers new hope for patients with end-stage heart failure complicated by cachexia."
Source: https://news.hubeidaily.net/hbrbsharenew/news_detail/5/5021668/4518472/0?w=1768381241426&uik=ed318141&share_plat=android&sec=c1e9022c&historyback=1
Edited by: Prof. WANG Yin, Department of Cardiovascular Surgery; International Exchange Office
