Recently, Professor Nianguo Dong's team in the Department of Cardiovascular Surgery at Wuhan Union Hospital successfully treated three patients with critical end-stage heart failure using the MoyoAssist® Extra-VAD.
Two of the cases were transseptal cannulation cases with MoyoAssist via the jugular vein and axillary artery. Prof. Dong's team has pioneered a minimally invasive interventional approach via extra-VAD to provide circulatory support for patients which is the first of its kind treatment in China, symbolizing a great milestone in China's medical science. This procedure minimizes surgical harm to patients and allows them to achieve upper-body cannulation without affecting the patient's mobility. It also allows patients to be stabilized while waiting for donor hearts. The patients would be able to eat or even exercise during the placement period.
Case Study 1
A 24-year-old male patient with dilated cardiomyopathy, NYHA class IV, and end-stage heart failure was admitted to Wuhan Union Hospital. During the waiting period, his condition gradually aggravated. On Jul 18th, 2022, the patient was transferred to the ICU. His blood pressure was 60~70/40~50mmHg and his heart rate was 82bpm, which put his life in a critical condition.
Prof. Dong's team established an extracorporeal circulatory support system by using transseptal cannulation to vent the left atrium through the jugular vein, using an end-to-side anastomosis technic to connect an artificial vessel and axillary artery for the outflow cannula insertion.
Professor Nianguo Dong's team in surgery
The procedure went well and the patient was returned to the ICU. The patient was awake 6 hours after the surgery. He was extubated 9 hours after the surgery and was able to eat. The intubation method was minimally invasive to the upper body and therefore did not affect the movement of the lower limbs. The patient was able to get out of bed the next day for exercise.
Overall, the patient was on the Extra-VAD for two weeks. He got his matching donor heart on the twelfth day after the operation. On that day, Prof. Dong's team successfully completed the heart transplantation and removed Extra-VAD. Due to the effective extracorporeal circulatory support, the patient's circulatory status was significantly improved. He had a rapid post-surgery recovery. A week later, the patient was transferred to a general ward.
Case Study 2
A 56-year-old male patient was transferred to the ICU of Wuhan Union Hospital in an emergency. He had end-stage dilated cardiomyopathy and malignant heart arrhythmia. The procedure went smoothly, and the patient was awake 6 hours after the surgery and extubated. 11 hours after the surgery. The patient could eat on his own 14 hours after the surgery. Under the support of the extra-VAD , the patient's circulation was stable and his appetite significantly improved compared with that before the operation.
“The transseptal cannulation method with MoyoAssist via jugular vein is a medical breakthrough. This medical breakthrough is a gospel from critical heart failure patients, especially those who are in end-stage heart failure and waiting for donor hearts. We truly hope that we may achieve a highly efficient, economical, and optimized treatment for Chinese patients through these local-developed products. The locally-developed extra-VAD could better meet clinical demands in China.” said Prof. Dong.
To get more opportunities for lives
There is an increasing number of heart failure patients. For patients with end-stage heart failure, heart transplantation is the best treatment option. Yet, due to the shortage of heart donors, the potential waiting time for patients is very long, which means patients with severe heart failure may have life-threatening problems at any time during the waiting process. The establishment of extracorporeal circulatory support may provide help for heart failure patients, and secure safety during the process of waiting for donor hearts, which also ensures more time for patients.
MoyoAssist Extra-VAD, the joint project developed by Prof. Nianguo Dong's team and magAssist Inc., is an important device for critical care treatment. Over the past year, it has achieved very promising results in multi-center clinical trials, all of which have successfully cured patients in various clinical centers.
Clinical data has shown that the short- to medium-term extracorporeal ventricular assist device has the advantages of low complications and effectiveness through long supporting time. In patients with acute heart failure but having good pulmonary function or patients undergoing cardiogenic shock, a short- to-medium-term extracorporeal ventricular assist device can provide effective circulatory support, which is likely to provide healthcare professionals more sufficient time to decide on the next step of treatment.
During these years, the Chinese government has encouraged medical device companies to lead nationalization research to drive the localization of high-end medical devices, meeting clinical demands in China so as to catch up with international innovators. In the past 20 years, China has successfully localized artificial vascular stents, artificial machinery valves, and biological valves, enabling patients to benefit from products while reducing the overall cost of medical care. The application of extra-VAD is expected to more precisely address the current unmet needs, while providing a more cost-effective option for both patient and healthcare systems in China.
"In addition to the common IABP, and ECMO, there are a series of mechanical circulatory support, such as extracorporeal ventricular assist device, which can perform support of the left, right ventricles, and bi-ventricular support Previously, there was a huge gap for this kind of treatment in China. It is our responsibility and obligation to drive innovation in the field of medical technology in China and to develop short and medium-term mechanical assist devices of international level and translate them into clinical use" said Prof. Dong.
'Extra-VAD has several innovations in concepts. First off, the full maglev centrifugal pump can suspend the rotating impeller in the blood field without any mechanical contact. This can minimize the damage to the blood cell. Secondly, the optimized flow channel design can provide stable flow and minimal shear force. Therefore, there is no need to combine with the membrane in clinical use. In addition, the device is easy to operate. It leads to fewer complications and requires less blood transfusion. The overall expense is relatively less compared to other treatments. It is suitable for acute heart failure treatment and pre-transplant transition support that could meet clinical pain points in China clinical scenarios, which is a gospel for both patients and healthcare professionals."