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中国心外科发展现状的幻灯

Cardiac Surgery in China Current status and Some Characteristics
Zhu Xiaodong
Fuwai Cardiovascular Institute  2004.10
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 year
    
Out of 16.6millions of newborns
 >100,000 babies with CHD (6.7 ‰) are added each year

                    * Report of the Ministry of Public Health. 2001

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 millions
            (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
Distribution of different 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 units

?Fuwai Hospital: (1977~2003)
    25,279 cases

Congenital
CABG
Valves
CABG  has gradually surpassed valve operations
Fu-Wai Hospital
Limited Medical resources The capacity of cardiac surgery
There are about 900 cardiothoracic units
     (including about 500 heart units)

Nearly 80,000 heart operations in 2003

13 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…)  
  
   
Our mission: Millions of  heart operations /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.
1. Increasing number of baby-patients
苏肇伉:心血管病国际论坛2004.09 北京characteristic
349 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
2. More complicated anomalies
About 25% are complicated cases
    Overall operative mortality ------10% to 15%

Unlike western countries, most cyanotic cases  are   Tetralogy 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
Improvement of Coronary Surgery
First CABG  1974   Guo Jiaqiang

  10%-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
Off-pump Coronary bypass
Number of OPCAB has been increasing
Out of total number of CABG, 20%-30% are off-pump in general.
A series of 1198cases (79.5% of total CABG)    Mortality 1.2%  Early results were satisfactory
It was 46% at FWH 2003
Promotion & competition from PTCA
? PTCA has been increasing much faster in recent years
      Especially since drug-eluting stent
     came into use.

? Sirolimus eluting stent has been 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 Disease
The majority of heart valve disease was rheumatic
Congenital
degenerative
(Fu Wai Hospital   1997~2003)
Heart Valve Surgery:
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 less (because of younger age and  re-operation..)
Home made Pericardial Since 1976,  The longest:AVR-21y;MVR-21y
 Valve Repair
Among the mitral valve operations
         Only around 10%----repair
         A variety of plastic rings are used
        Alfieri edge to edge technique: for ischemic
          mitral regurgitation  
TV: Exclusively ---  reconstruction technique
           De Vega or Ring
AV repair:  Only limited indications
        AS, Prolapse of leaflets,     AV-ring dilatation

Minimally Invasive Procedures for heart valve surgery
Right thoracotomy
Partial sternotomy
Beating heart with ECC
Endoscopy assisted
 
11%
Fu Wai Hospital  Data:1997~2000)
 Surgery 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 intervention
    Elephant procedure  60 cases    (FWH 1997-2003)
     Ascending aorta and total arch replacement combined with   stented graft implantation into the descending aorta
 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-l


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