CMICS: The Leap and Rebalancing of Minimally Invasive Cardiovascular Surgery in China

In the history of medicine, few specialties have undergone such thorough self-renewal as cardiovascular surgery in just a decade. From traditional open-heart surgery to transcatheter therapy, from cardiopulmonary bypass to off-pump procedures, and to the rise of robotic surgery, ultrasound navigation, and intelligent surgical systems, "minimally invasive" has evolved from a technical term to the direction of disciplinary progress. Over the past six years, China's minimally invasive cardiovascular surgery has achieved a leap from concept popularization to system restructuring at an astonishing pace: technological boundaries are expanding, regional gaps are narrowing, and the disciplinary structure is rebalancing.

On October 25, 2025, the China Minimally Invasive Cardiovascular Surgery Congress (CMICS) was held in Quanzhou, Fujian. Professor Wang Chunsheng — Chairman of CMICS and Director of the Department of Cardiac Surgery at Zhongshan Hospital Affiliated to Fudan University — released the 2024 statistical data on minimally invasive cardiac surgeries. This article is based on CMICS data from 2019 to the present and the 2024 White Paper on Cardiovascular Surgery and Cardiopulmonary Bypass Data in China.

1. From Concept Popularization to Mature System

Between 2019 and 2024, China's cardiovascular surgery underwent profound structural restructuring. Among over 360,000 cardiac surgeries nationwide, minimally invasive and interventional technologies are no longer supplementary but have become a dominant force.

In 2019, when CMICS first released national data, the key phrase was "rapid momentum"; by 2023, the wording shifted to "stable systems formed for various minimally invasive procedures."

In 2023, the number of minimally invasive cardiovascular surgeries reached 98,401, a 39.8% increase from 2021; in 2024, it climbed to 117,486, a 19.4% year-on-year growth. Minimally invasive congenital heart defect correction under cardiopulmonary bypass increased 22.8%, minimally invasive coronary artery bypass grafting (MICS-CABG) 35.5%, and minimally invasive aortic surgeries 42.3% — the fastest-growing segment.

2. Rebalancing of the Surgical Landscape

The 2024 White Paper shows 789 hospitals nationwide performed 360,765 cardiac surgeries, with cardiopulmonary bypass at 55.8% and off-pump procedures at 44.2%. This is the first time the ratio of traditional open-heart surgery to minimally invasive interventional technology has approached 1:1.

Coronary artery bypass grafting (CABG) and heart valve surgery remain the mainstays, with 80,016 cases (22.2%) and 92,488 cases (25.6%) respectively. By 2024, the minimally invasive proportion in these two segments rose to 24%.

3. Regional Expansion and System Balance

A decade ago, China's cardiac surgery hubs were concentrated in Beijing, Shanghai, Wuhan, and Guangzhou. This pattern broke in the past three years. From 2023 to 2024, East China still led, but North China and Central-South China recorded the fastest growth at 48.6% and 30%; Northwest China's minimally invasive CABG surged 115.8%, ranking first nationwide.

4. Liaocheng Model: Grassroots Breakthrough and Replication

The rise of Liaocheng Heart Hospital (Dong'e County People's Hospital) is highly representative. In 2023, it ranked third nationwide with 261 minimally invasive coronary artery bypass surgeries, second only to Peking University Third Hospital and Beijing Anzhen Hospital — the first county-level hospital to enter the national top three in five consecutive years of CMICS statistics.

As a training center of Fuwai Hospital, the Liaocheng team received systematic training, with core members studying at the Cleveland Clinic, Mayo Clinic, and UCD Medical Center. Its minimally invasive ratio reaches 70%, and 90% for coronary artery bypass. Out-of-pocket expenses are only one-third of those at top Beijing and Shanghai hospitals.

5. International Comparison: China's Speed from the STS Perspective

Professor Wang presented data from the international STS Adult Cardiac Surgery Database. As of 2024, annual MICS-CABG and robotic CABG in the US exceeded 1,000 and 1,500 cases; TAVR surpassed 100,000 in 2023. In 2024, China's MICS-CABG reached 5,063 cases (+35.5%), minimally invasive valve surgeries 18,000 cases (+18.3%), and minimally invasive aortic surgeries 2,478 cases (+42.3%).

6. Global New Technology Wave

In 2025, robot-assisted surgery, sutureless anastomosis systems, pure ultrasound navigation, and AI image assistance became the direction of innovation. China is evolving from a technology importer to an important participant in technology export and standard-setting. Zhongshan Hospital launched China's first "physical heart valve disease center."

7. From Quantitative Growth to System Balance

Hospitals performing over 1,000 surgeries annually account for only 10.5% of the total yet complete 67.7% of national surgeries. A three-level symbiotic system has taken shape: top-tier centers as innovation engines, regional centers as training hubs, and grassroots hospitals as inclusive terminals. China's cardiac surgery strength is transitioning from "center-driven" to "system-driven."

Conclusion

The transformation of cardiovascular surgery in China is a testament to the power of innovation and collaboration. Advances in minimally invasive techniques not only enhance patient outcomes but also reduce recovery times, moving toward more patient-centered care.