China Health Trip takes you through the latest medical breakthroughs in China, showcasing the possibilities of advanced healthcare. Read on for more insights.

Thirty-six hours after receiving the heart transplant, 67-year-old Fu Bo was extubated and several ECGs showed no signs of myocardial ischaemia. Currently, Fu Bo’s heart and all organ functions have recovered successfully, and he will be discharged from the hospital in the near future.

On 16 July 2021, at a press conference held at the First Affiliated Hospital of Sun Yat-sen University, Uncle Fu expressed his gratitude to the medical staff. This is the world’s first successful ‘no ischemia’ heart transplantation, but also Zhongshan First Hospital pioneered the ‘no ischemia’ organ transplantation technology following the application of liver transplantation, kidney transplantation, the first time in the field of heart transplantation, the operation to achieve the whole process of blood flow is not interrupted, During the operation, the blood flow was not interrupted and the heart did not stop beating.

The revolutionary innovation of ‘ischemia-free’ organ transplantation has also provided a ‘Chinese model’ for organ transplantation.

Exploring ‘ischemia-free’ heart transplantation and conducting dozens of large animal experiments in the past two years.

The heart is the power source of life, and once the heart stops beating, it means the death of life. For heart failure patients, heart transplantation technology brings them hope. However, the road to ‘rebirth’ is not smooth.

During traditional transplantation, the heart must be isolated, stopped and refrigerated, and myocardial ischemia damage will inevitably occur, and myocardial ischemia is the most important factor affecting the patient’s prognosis, which can lead to postoperative cardiac insufficiency in the recipient, the heart is not functioning, and even the patient’s death and other serious consequences.

Professor He Xiaoshun, Vice President of Zhongshan First Hospital and leader of Organ Transplantation Science Section, introduced that as the heart is the most sensitive organ to ischaemic injury, the risk of surgery will increase significantly if the time of isolated ischaemia is more than 6 hours. How to crack the problem of ischaemic injury during heart transplantation has been a key research direction for scientists around the world.

Because of the unique and complex physiological characteristics of the heart, ‘ischemia-free heart transplantation’ has gone through a particularly arduous process from the conception to the clinical transformation compared with ischemia-free liver and kidney transplantation. Firstly, it is necessary to solve the problem of maintaining the ‘ischemia-free, fresh and vigorous beating state’ during the ‘whole process’. Secondly, whether the conventional heart transplantation method, especially the acquisition and anastomosis part, can be carried out smoothly when the heart is beating. The last is the unity and harmony of man, heart and machine.

Under the strong support of Xiao Haipeng, Executive Vice President of Sun Yat-sen University and President of Sun Yat-sen First Hospital, a multidisciplinary team of Organ Transplantation, Cardiac Surgery, Extracorporeal Circulation and Surgical Anaesthesia Centre of Sun Yat-sen First Hospital has formed a joint research group and after more than two years of painstaking exploration, carried out dozens of cases of large-animal experiments, and started from scratch, continuously designed, mapped out, verified and optimized the perfusion surgical plan, and finally explored a set of brand-new heart Finally, a new heart transplantation technique was developed and named ‘Ischemia-free Heart Transplantation (IFHT)’. The successful application of this technique means that ‘marginal donor hearts’, which were previously judged to be inaccessible, could potentially become a boon for more patients; and it could also bring forward the existing stage of functional assessment of the donor heart, ‘dramatically improving the prognosis of heart transplantation’.

In order to ensure a safe transition from the experimental stage to clinical application, the team has also completed more than 10 clinical ‘ischemia-free’ heart acquisition and isolated normothermic mechanical perfusion drills, laying a solid foundation for the clinical application of the new technology.

The team challenges ‘ischemia-free’ heart transplantation for patients with end-stage cardiac lesions

With everything ready, the heart transplant team was waiting for a suitable patient to show up. 67-year-old Fu Bo was diagnosed with dilated cardiomyopathy during his visit to Zhongshan First Hospital on 24 May, and the results of cardiac MRI, echocardiogram, and blood tests all indicated that Fu Bo’s heart had entered the end stage, and that the left ventricular systolic function – the most important source of power for the heart – had entered the end stage. –The systolic function of the left ventricle had been reduced to one-fourth of the normal level. At the same time, he also suffered from hypertension, atherosclerosis, pulmonary hypertension, renal hypoplasia and other underlying pathologies.

After an MDT consultation with more than 10 specialties, including cardiac surgery, cardiology, and organ transplantation, the experts agreed that, except for heart transplantation, the rest of the conventional surgical treatments could no longer solve Fu Bo’s heart problems. In addition, because Fu Bo suffers from severe cardiomyopathy, heart failure, and a combination of more than moderate pulmonary hypertension, he faces a high risk if a traditional heart transplant is performed.

Over time, Faubert has needed to undergo intra-aortic balloon implantation and ventilator-assisted respiration, and has entered the emergency sequence of waiting for a transplant.

On 26 June, after waiting for a suitable donor, Professor He Xiaoshun hosted a pre-operative preparatory meeting for the first ‘ischaemia-free’ heart transplant, which was attended by Liu Qiusheng from the Department of Medical Services, Professor Wu Zhongkai, Director of Cardiac Surgery, Yin Shengli, Deputy Director of Cardiac Surgery, Rong Jian, Director of the Department of Extracorporeal Circulation, Professor Guo Zhiyong from the Department of Transplantation, Professor Jiang Nan from the Department of Anaesthesiology, Tang Baiyun, Director of the Surgery and Anaesthesia Centre, and Gong Baiyun, Head of Surgical Anaesthesia Centre. The heart transplant team, consisting of experts from more than 10 disciplines, including Gong Fengqiu, head nurse of the Surgical Anaesthesia Centre, had a preoperative discussion for more than three hours.

The team of experts conducted an exhaustive rehearsal of the surgery’s planning, implementation details, emergency plans, etc., and simulated and rehearsed various situations that might occur during the surgery to ensure that the surgery was flawless.

Wu Zhongkai said that Fu Bo’s physical condition was not an ideal candidate for ‘ischaemia-free’ heart transplantation, but the patient’s condition was critical and in need of a heart transplant, and the risk was even greater if he underwent conventional transplantation. ‘At that time, we had already made sufficient preparations, and we were more confident and certain that we could save the patient with ‘ischaemia-free’ heart transplantation,’ he said. He said.

At that time, it was during Guangzhou’s fight against the new coronary pneumonia epidemic, and the operation had to be carried out in line with both the overall situation of fighting the epidemic and the principle of organ transplant allocation. For the team of doctors, performing an ‘ischemia-free’ heart transplant for Fu Bo was both a challenge and an opportunity.

No blood shortage and non-stop beating, demonstrating strong power of organ maintenance

At 2:00pm on 26 June, Fubo and the recipient donor entered the operating room at the same time. Fu Bo first received a floating catheter check, and after measurement, Fu Bo’s pulmonary artery pressure, although still high, had dropped to a level where he could undergo surgery. Cardiac Surgery Professor Wu Zhongkai and Associate Professor Liang Menya started to remove Fubo’s huge diseased heart that could only peristalsis. On the other hand, the donor acquisition team of Cardiac Surgery, consisting of Professor Yin Shengli, Associate Professor Xiong Mai, Dr Liu Yunqi, Nurses Pan Pengfei and Zhong Ying, etc., methodically acquired the donor heart, which was found to be in a good condition and strong and powerful after probing, and more than 40 medical and nursing staffs from the two operating theatres were put into an unprecedented ‘heart replacement battle’. The two operating theatres, with more than 40 medical and nursing staff, were engaged in an unprecedented ‘heart replacement battle’.

Drs. Jiang Nan and Xiong Wei from the Department of Anaesthesiology provided a smooth anaesthetic for the donor. Professor Rong Jian, Dr. Cao Lu, Dr. Shi Han, Ms. Zhu Yanling, and Mr. Shi Yongshu of the Department of Extracorporeal Circulation specially designed a set of exquisite perfusion and heat preservation system for the donor’s heart. With the surgeon’s rapid and sharp placement of the tube and block, the extracorporeal cardiac perfusion began to work, and the donor’s heart, which had been freed from the pericardial cavity, was vibrantly and powerfully beating in the organ tank without a moment’s pause and maintained a normal temperature, and was smoothly transported to the recipient’s operating room. transferred to the recipient’s operating room.

Dr Li Hanzhao put on special gloves and carefully transferred the beating donor heart from the transfer tank to the pericardial cavity of Fu Bo. Professors Wu Zhongkai and Yin Shengli performed the donor heart anastomosis while the heart was still beating strongly. Under the operating table, the anaesthesiology team of Yuan Baolong, Jiang Nan, and Xiong Wei monitored Fu Bo’s respiratory, circulatory, and neurological status and adjusted the medication. The extracorporeal circulation team of Li Yi, Mo Shaoyin, Xiao Jiefei, Jiang Yumei, and Li Yonghua have long been beside Fu Bo for the maintenance and escort of other organ functions of the whole body under extracorporeal circulation. Chen Xiaojun, Gao Yi, Guo Qin and other nursing team, under the co-ordination of Nurse Gong Fengqiu, methodically did a good job in the management of equipment and machinery, continuous and effective insulation, pipeline care, PI prevention and other nursing management. On-site and off-site, professors Xiao Haipeng, He Xiaoshun, Dong Yugang, and Guo Zhiyong guided and coordinated the whole process.

The surgery achieved effective blood flow without interruption during the whole process of heart acquisition, preservation by perfusion in vitro and implantation, and the heart was always in a physiological beating state. When the heart was implanted, a scene of ‘dual circulation within and outside the heart’ technology collaboration appeared in the operating theatre, demonstrating the strong comprehensive strength of Zhongshan First Hospital in medical innovation, medical collaboration and management.

Putting the beating heart into the patient’s chest cavity, the faster the better. The time record is that the whole process of donor heart cutting down and perfusion repair took only 62 minutes, while the recipient heart anastomosis to the successful suture took only 61 minutes. ‘The details of the perfusion scheme and the surgical plan were tested and discussed countless times over more than two years.’ Rong Jian said.

The ‘ischemia-free’ heart transplant lasted 4.5 hours, enabling the donor heart to be transplanted to the recipient with ‘no interruption in blood supply’ and ‘no stopping of the beat’. Fu Bo returned to the cardiothoracic ICU after the operation. Under the close monitoring, timely adjustment, and rehabilitation of the medical team of Drs. Baiyun Tang, Bao Zhang, Li Si, and Song Yang, and the nursing team of Drs. Weihua Xue, Jinxian Wang, Minling Yang, Yingru Li, and Chunxiao Li, Fu Bo’s tracheal tube was removed 36 hours after the operation, and no signs of ischemia were found in his ECGs, and his cardiac ejection fraction increased to 78% from the preoperative level of 16%. Echocardiography showed that the ejection fraction of the heart increased from 16% before the operation to 78%, and the pressure of the pulmonary artery decreased ideally after the operation. At present, the patient has passed the systemic inflammatory reaction syndrome in the early postoperative period, and the functions of the heart and all organs have recovered successfully, and he can be discharged from the hospital recently.

The ‘bloodless’ technology has pushed organ transplantation into a new era

At the press conference of the world’s first ‘ischemia-free’ heart transplant, Huang Jiefu, former Vice Minister of Health and Chairman of China Organ Donation and Transplantation Committee, sent his congratulations, saying that Zhongshan First Hospital has always been the forerunner of China’s organ donation and transplantation reforms, and that the success of this heart transplant has once again proved that the ‘ischemia-free’ heart transplantation has been successful and the heart transplantation has been successful. He said that the success of this heart transplant once again proved the maturity and innovation of ‘ischemia-free’ organ transplantation technology. He hoped that Zhongshan First Hospital would continue to make new contributions to China’s organ transplantation technology to reach the peak of the world stage.

Stefan Tullius, Chief of Transplantation Surgery and Director of Transplantation Surgery Research at Brigham and Women’s Hospital, and Professor of Surgery at Harvard Medical School, believes that this is a milestone in organ transplantation, which will improve the quality of the organs and increase the utilisation of the organs, and at the same time, provide a basis for further research into the effects of ischaemia and reperfusion injury on transplantation immunity.

Bjorn Nashan, Past President of the European Society of Transplantation, commented, ‘The procedure further demonstrates the feasibility of ischaemia-free heart transplantation, while having the potential to significantly reduce the chances of patients being at risk of developing vasculopathy in the transplanted heart, contributing to improved post-transplantation survival and providing an incalculable benefit to patients in need of heart transplantation. ’

This is not the first time that Zhongshan First Hospital has performed ‘ischemia-free’ organ transplants. In order to achieve ‘ischemia-free’ transplants, Zhongshan First Hospital has also developed the world’s first multifunctional maintenance system for organ isolation.

On 23 July 2017, Professor He Xiaoshun’s team operated on a patient with cirrhosis combined with small liver cancer, completing the world’s first ‘ischemia-free’ liver transplant. The team took the lead in developing the world’s first extracorporeal multi-organ repair system (Life-X), which creates near-physiological conditions of perfusion pressure, temperature, oxygenation, and nutritional support for isolated multiple organs, solves the problem of maintaining the vitality of isolated organs, and further revolutionises transplantation surgery to ensure that blood flow to organs is not interrupted during the process of organ vascular disarticulation and reanastomosis. At present, 90 cases of ‘ischemia-free’ liver transplantation have been carried out in Zhongshan First Hospital, which has significantly improved the prognosis of transplantation, with significant improvement in liver function and survival rate after surgery.

On 9 April 2018, ‘ischemia-free’ organ transplantation technology was applied to kidney transplantation for the first time, with the operation taking only 3 hours, and the transplanted kidney was continuously perfused throughout the donor’s body, acquisition and transplantation process.

The prospect of “ischemia-free” heart transplantation

At present, the creation of ‘ischemia-free’ heart transplantation technology, together with ‘ischemia-free’ liver transplantation and kidney transplantation technology, constitutes the system of ‘ischemia-free’ organ transplantation technology, which brings the development of organ transplantation into a brand new era. This has brought the development of organ transplantation into a brand new era and demonstrated to the world the ‘China Model’ of revolutionary innovation in organ transplantation.

In April 2021, He Xiaoshun’s project of ‘Bloodless’ Organ Transplantation Technology Opens the Era of ‘Hot Transplantation’ won the Grand Prize of the 2020 International Quality Innovation Competition, which is the first time for China to win such a prize. The American Journal of Transplantation commented that this is ‘a milestone in the history of organ transplantation, and organ transplantation will enter the era of “hot transplantation”.’ Nancy Ascher, President of the World Transplantation Association, said, ‘’Ischemia-free‘ organ transplantation can be expanded to heart, lung and kidney transplantation, and can be extended to other regions of the world, which has a broad application prospect’.

Xiao Haipeng said that Zhongshan First Hospital should continue to carry out institutional mechanism innovation and medical science and technology innovation to achieve more ‘0 to 1’ innovations and contribute to a healthy China.