Progress in Minimally Invasive Cardiovascular Surgery in China

Abstract & Introduction

Minimally Invasive Cardiovascular Surgery (MICS) is one of the fastest-developing subspecialties in cardiovascular surgery. With less trauma, fewer complications, and faster recovery, MICS is a key development direction. The China National Minimally Invasive Cardiovascular Surgery Professional Committee (CMICS) promotes aligning domestic techniques with international standards. This article summarizes MICS progress in China, its clinical effects, and future trends.

Background and Current Status

MICS began in the late 20th century, with the first minimally invasive Coronary Artery Bypass Grafting (CABG) in 1995. It is now systematic and routine in key centers. China has a large population needing cardiovascular surgery: in 2023, the total number of cardiovascular surgeries reached 341,804, up 29.8% year over year, with minimally invasive procedures now accounting for almost 30%. Compared to traditional open-chest surgery, MICS offers smaller trauma, fewer complications, and faster recovery. However, it faces challenges including high technical difficulty, a long learning curve, and high equipment costs.

1. Major Technical Progress in MICS in China

1.1 Minimally Invasive Valvular Heart Surgery

MICS has achieved significant results in aortic, mitral, and tricuspid valve disease. Minimally invasive mitral valve repair is the preferred method for degenerative mitral regurgitation. Interventional procedures like Transcatheter Aortic Valve Replacement (TAVR) are widely adopted, extending to intermediate- and low-risk patients. Transcatheter Edge-to-Edge Mitral Valve Repair (TEER) is also safe and feasible for high-risk groups.

1.2 Minimally Invasive Atrial Fibrillation (AF) Surgery

AF is a common arrhythmia that can lead to stroke. Minimally invasive epicardial radiofrequency ablation is superior in maintaining sinus rhythm. Notably, the Mei Mini Maze procedure, pioneered by Chinese experts using a unilateral left thoracotomy, reduces surgical trauma and increases AF ablation success rates. The "Hybrid" ablation technique, combining epicardial and endocardial ablation, has the highest success rate for complex AF. Left Atrial Appendage (LAA) closure reduces stroke risk and is often recommended, offering an option for patients who cannot take long-term anticoagulants. Synchronous AF ablation is recommended when performing surgery for valvular disease combined with AF, as it improves survival and reduces thrombosis risk.

1.3 Minimally Invasive Coronary Artery Bypass Grafting (CABG)

Minimally invasive CABG, combining off-pump surgery and small incisions, has survival rates similar to traditional surgery but offers less trauma, less transfusion, and lower costs. Advances include robotic-assisted CABG. Traditional open surgery remains the choice for complex multi-vessel disease or synchronous cardiac procedures.

1.4 Minimally Invasive Congenital Heart Disease (CHD) Surgery

Minimally invasive Ventricular Septal Defect (VSD) repair via a small axillary incision is widely used. Interventional procedures for CHD (ASD, VSD, PDA) have progressed significantly. Biodegradable occluder devices show great promise thanks to their biocompatibility and reduced long-term complications.

1.5 Minimally Invasive Hypertrophic Obstructive Cardiomyopathy (HOCM) Surgery

The modified Morrow procedure combined with edge-to-edge mitral valve repair, performed via minimally invasive right thoracotomy, reduces trauma while maintaining efficacy. The Transapical Off-Pump Septal Myectomy (TA-BSM) is a new, feasible treatment option for HOCM.

1.6 Minimally Invasive Aortic Surgery

Endovascular Aortic Repair (EVAR) and minimally invasive small-incision surgery offer new choices for aortic disease. Small-incision surgery through partial sternotomy is used for complex procedures like aortic root reconstruction.

2. Current Limitations and Challenges

• Technical and equipment limitations: high precision is required, and advanced equipment is expensive.
• Patient factors: not all patients are suitable for minimally invasive treatment.
• Surgical experience: new techniques require systematic training, and lack of experience increases risk.
• Conversion risk: procedures may need conversion to traditional open surgery due to complexity.

3. Outlook

MICS has broad prospects and is expected to become the mainstream of cardiovascular surgery. China must strengthen innovation, international exchange, data support, and policy guidance. The future involves further technical fusion and multidisciplinary collaboration for more precise, personalized treatment.

Citation: Mei J, Jiang ZL, Wang C. Progress in Minimally Invasive Cardiovascular Surgery in China. Chinese Journal of Cardiovascular Research, 2025, 23(4): 289-292.