The implant of the circulatory support system took root in a child with borderline body weight


In April 2021, doctors from Sverdlovsk OKB No. 1 (SOKB No. 1) for the first time implanted the HeartMate III circulatory support system in a 10-year-old child. Previously, in Russia only adult patients underwent such interventions; only three implantations of the system were performed, the first took place in February 2020 under the leadership of the chief cardiac surgeon of Russia Leo Boqueria.

Disease history

The child was admitted to the pediatric cardiology department of Special Hospital No. 1 in September 2020 with infectious endomyocarditis that developed as a result of tracheobronchitis, doctors who took part in the operation and postoperative recovery of the patient said at a press conference on May 18. On the same day, specialists performed an operation to replace the mitral valve destroyed by infection with a mechanical prosthesis.

After the intervention, the child spent 7 days on extracorporeal membrane oxygenation (ECMO), then was in intensive care on artificial ventilation. During this time, it was possible to partially restore the function of the left ventricle and transfer the patient to the department, where he received conservative therapy for cardiovascular failure, antibiotic therapy and antiviral therapy to prevent relapse of infection.

In December 2020, the child suffered from COVID-19 and was temporarily transferred to a specialized hospital. The disease led to complications such as the development of heart failure and decreased tolerance to physical activity.

“The first month after the operation the patient had positive dynamics. Then, unfortunately, the main process of myocarditis began to progress again and the left ventricular ejection fraction decreased critically, to 11%. We understood that the child had no prospects and began searching for a device and specialists who could help us perform the operation to replace the left ventricle with a mechanical system,” said the head of the pediatric cardiac surgery department of Regional Clinical Hospital No. 1, who led the operation. Konstantin Kazantsev.

Operation

The child had borderline physical parameters for installing the system, says Kazantsev. At the time of the operation, the patient weighed 24 kilograms, the body surface area “barely reached” one square meter.

The operation lasted 4.5 hours, it was attended by about 30 specialists, including doctors from the Prague Institute of Clinical and Experimental Medicine: Director of the Cardiology Center, Professor Jan Pirk and doctor of the department of anesthesiology and resuscitation Thomas Kotulyak. Kazantsev led a team of doctors from SOKB No. 1, which included the head of the Heart and Vessels Center at the hospital Konstantin Kondrashovcardiac surgeon Daria GoncharovaHead of the Department of Anesthesiology and Intensive Care for Children Alexey Svalovdoctor of the department of anesthesiology and resuscitation Andrey Tyulpin.

Today the child is undergoing rehabilitation; doctors assess his condition as satisfactory. While the HeartMate III system performs the functions of the left ventricle in the patient’s body, he will be forced to take anticoagulant and desogestant therapy.

“We are only at the very beginning of the journey, if everything goes well for him, the system works, there are no complications, then he will continue to live with this system. If his myocardial function is restored, we will explant this system,” explains Kazantsev.

System

The HeartMate III circulatory support system was developed by Abbott Laboratories. The basic operation of the device is a motor with a rotor levitating in a magnetic field, which pumps blood from the left ventricle to the aorta without coming into contact with other parts of the device. This practically eliminates all complications associated with damage to blood components, notes the press service of SOKB No. 1.

The device was initially used to support blood circulation before heart transplantation, and then it began to be permanently implanted in patients who are contraindicated for heart transplantation due to age or other factors.

In 2019, Abbott announced a recall of devices due to malfunctions in the mobile power supply. The unit could suddenly shut down due to static electricity. Then the company received two complaints about serious adverse events due to incorrect operation of the device.

In May 2017, Abbott recalled more than 28 thousand controllers of the previous generation HeartMate II systems, the US Food and Drug Administration (FDA) reported. This device model was not registered and was not purchased in Russia. The manufacturer received 70 reports of “incidents involving controller malfunction after replacement.” In 26 cases, after trying to replace the controller themselves, patients died, in 19 cases they received various injuries.



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