1、1,Cardiac Surgery in China Current status and Some Characteristics,Zhu Xiaodong Fuwai Cardiovascular Institute 2004.10,2,CHINA: A developing country with a huge population of 1.3 billions*,Even the growing pace of the population has gradually slowed down Increasing rate: still as high as 0.7% per ye
2、ar Out of 16.6millions of newborns100,000 babies with CHD (6.7 ) are added each year* Report of the Ministry of Public Health. 2001,3,Potential Patients who may need cardiac surgery:,Myocardial infarction 2.967 millions* Rheumatic valvular disease 2.235 millions Congenital heart disease 1.80-1.95 mi
3、llions（6.7 in newborns) Idiopathic cardiomyopathy 1.60 millions* Others Total 8millions*Gu Dongfeng. Prevalence of cardiovascular diseases in China 42nd conference on cardiovascular disease epidemiology and prevention 2002.04 Hawaii *Yubao Zou et al. Am J Medicine 2004,116:14-8,4,Distribution of dif
4、ferent kinds of heart operations,In general :Number one:Congenital (60%-65%)Second: Valve surgery (20%-25%);Third:Coronary surgery (10%-20%）*CABG 50% in few unitsFuwai Hospital： (19772003)25,279 cases,Congenital,CABG,Valves,5,CABG has gradually surpassed valve operations,Fu-Wai Hospital,6,Limited Me
5、dical resources The capacity of cardiac surgery,There are about 900 cardiothoracic units(including about 500 heart units) Nearly 80,000 heart operations in 200313 big heart centers (1000 open hearts/year)(阜外, 安贞, 新华, 上海中山, 长海, 武汉协和, 亚心, 霍英东, 湘雅, 沈军区, 华西, 四医大, 三医大),7,Our mission: Millions of heart op
6、erations /y,Another hundred of heart centers as big as Fu-wai heart hospital or as good as THI should be built up in China. A whole network of service and a reliable insurance system nationwide also should be established.,8,1. Increasing number of baby-patients,苏肇伉：心血管病国际论坛2004.09 北京characteristic,3
7、49 operations of complicated congenital heart diseases. 57 under 6 months of age 徐志伟)*： *晚期心脏病外科治疗研讨会，上海 2004,Surgery of Congenital Heart Disease,9,2. More complicated anomalies,About 25 are complicated casesOverall operative mortality -10% to 15Unlike western countries, most cyanotic cases are Tetr
8、alogy of Fallot ( mortality 1.1%-5%) Because of small percentage of neonates.In a series of 115 neonates of congenital heart disease nearly 50% of them were TGA*苏肇伉：心血管病国际论坛2004.09 北京,Surgery of Congenital Heart Disease,Continue,10,Improvement of Coronary Surgery,First CABG 1974 Guo Jiaqiang,11,10%-
9、20% of total number of heart operations in general (in few heart centers, the percentage of CABG has been as high as 50%)Operative mortality: 2%-3% in big centers,The number of CABG,FWH,12,Off-pump Coronary bypass Number of OPCAB has been increasing Out of total number of CABG, 20%-30% are off-pump
10、in general. A series of 1198cases (79.5% of total CABG) Mortality 1.2% Early results were satisfactory,It was 46% at FWH 2003,13,Promotion & competition from PTCA, PTCA has been increasing much faster in recent years Especially since drug-eluting stentcame into use. Sirolimus eluting stent has been
11、widely used in China. PTCA was one and a half times more than CABG at FWH PTCA is still facing “re-stenosis” Guideline update: severe proximal LAD stenosis and/or 3-vessel disease may achieve improved survival with CABG. So, Surgeons will have more complicated or restenosis cases.,Etiology of Valve
12、Disease,The majority of heart valve disease was rheumatic,Congenital,degenerative,(Fu Wai Hospital 19972003),Heart Valve Surgery:,15,Technically popularized MVR AVR Valve prosthesis:Mechanical 90% : G-K,Lanzhou,St.Jude,M,A,FW 97-03,Valve Replacement First case - 1965 Cai Yongzhi,Tissue valves: much
13、less (because of younger age and re-operation),Home made Pericardial Since 1976, The longest:AVR-21y;MVR-21y,16,Valve Repair,Among the mitral valve operations Only around 10%-repairA variety of plastic rings are usedAlfieri edge to edge technique: for ischemicmitral regurgitation TV： Exclusively - r
14、econstruction techniqueDe Vega or Ring AV repair: Only limited indications AS, Prolapse of leaflets, AV-ring dilatation,17,Minimally Invasive Procedures for heart valve surgery,Right thoracotomy Partial sternotomy Beating heart with ECC Endoscopy assisted,11%,Fu Wai Hospital Data:19972000),18,Surger
15、y of Aortic Aneurysm,The aortic arch replacement was started -1960th The operative mortality of dissecting aneurysm has come down to 6.8%-10.1% recently. Surgery + Intra-vascular interventionElephant procedure 60 cases (FWH 1997-2003)Ascending aorta and total arch replacement combined with stented g
16、raft implantation into the descending aorta,19,Surgical Treatment for End stage Heart Failure,Basically there are 3 approaches: 1. Heart, heart-lung transplantation Very effective and important Very limited number so far. Heart and heart-lung transplants are less than 200cases More heart centers hav
17、e started heart transplantin many provinces recently.,20,A new design at FWH The 3rd Generation of VADMegnetic activated subaortic pump,Surgical Treatment for End stage Heart Failure,continue,2. Ventricular assist device(VAD)Novacor, BAS, Meados, Berlin HeartIt is too expensive and complex technical
18、ly,21,Surgical Treatment for End stage Heart Failure,3. Cell transplantation It is now only in the stage of basic research, and very few primary clinical trial. Mostly: Using marrow stem cells (put stem cells into coronary artery),Continue,22,Summary,China, as a developing country, there are some ch
19、aracteristics in cardiac surgery.1. huge and continue growing patient population. 2. Increasing coronary heart disease, CABG is movingto the second largest group in cardiac surgery.3. Rheumatic is the main cause of heart valve disease.Very small percentage of tissue valves are used.4. The majority o
20、f cyanotic congenital heart disease is Tetralogy of Fallot,23,Summary continue,Cardiac surgery in China is now at its full speed of development. From the point of technology in the field of coronary and valvular surgery, there is no significant gap compared with developed countries. As to neonate heart surgery and aortic surgery, we have a rather long way to go.,24,Lastly, I hope the information I provided here may encourage you to extend your practice or collaboration in the near future.,25,Thankyou,
