In recent years, the field of cardiovascular surgery has undergone revolutionary changes and made rapid progress in various aspects, bringing more hope and possibilities for the health and well-being of patients. The constant emergence of new technologies brings new opportunities and hope, as well as constant challenges to past concepts. This article aims to provide a comprehensive overview of the latest developments in cardiovascular surgery in recent years, especially since 2023. It introduces cutting-edge knowledge and technologies in the field of cardiovascular surgery, including lifelong management of aortic valve disease, artificial valves, mitral valves, treatment options for hypertrophic obstructive cardiomyopathy, heart transplantation, left ventricular assist, coronary artery surgery, cardiac structural interventions for chronic heart failure, aortic dissection, and comprehensive surgical treatment of atrial fibrillation. It also analyzes and explores future development directions in depth, aiming to provide useful references and inspiration for cardiovascular doctors and jointly promote the continuous progress of cardiovascular surgery in China.
Objective To systematically analyze the disease burden, long-term trends, and age-sex distribution of major valvular heart disease (VHD) subtypes—rheumatic heart disease (RHD), non-rheumatic valvular disease (NRVD), and non-rheumatic calcific aortic valve disease (CAVD)—in global, Chinese, and US populations from 1990 to 2021, providing evidence for public health strategies and clinical resource allocation. Methods Based on publicly available data from the Global Burden of Disease (GBD) Study 2021, we extracted incidence, mortality, and disability-adjusted life years (DALYs) for VHD from 1990 to 2021. Age-standardized rates (ASRs) were calculated using the GBD 2021 global standard population, and the estimated annual percentage change (EAPC) with its 95% uncertainty interval (UI) was computed for the period. Data from the US Healthcare Cost and Utilization Project (HCUP), the European Society of Cardiology (ESC)/Eurostat surveys, and Chinese national registries were used for trend triangulation and contextual background. Results From 1990 to 2021, the ASR and disease burden of RHD significantly decreased globally and in China (EAPC for DALYs in China: ?4.8%, 95% UI: ?5.0% to ?4.6%). In contrast, the burden of NRVD and CAVD has been steadily increasing in aging populations like those in China and the US, with a higher burden observed in older adults and males. In 2021, the incidence of NRVD and CAVD peaked in individuals aged ≥65 years, with rates being significantly higher in men than in women. RHD burden was concentrated in low Socio-demographic Index (SDI) regions, whereas NRVD/CAVD burden was strongly associated with high-SDI regions. ConclusionThe global VHD epidemiological landscape is transitioning from an RHD-dominant to an NRVD/CAVD-dominant pattern. China faces a dual challenge of a residual RHD burden and a rapidly growing burden of degenerative valvular diseases. Developing tailored screening, prevention, and treatment strategies for different disease subtypes and populations is crucial.
Pulmonary arterial hypertension (PAH) is a severe, progressive disease leading to right ventricular failure and finally death. Lung transplantation is recommended for PAH patients who do not respond to targeted drug combination therapy or World Health Organization functional class (WHO FC) Ⅲ or Ⅳ. However, only 3% of PAH patients can recieve the lung transplantation. A novel implantable interatrial shunt device (ISD) can create a relatively fixed right-to-left shunt established by balloon atrial septostomy (BAS). The device may decompress the right sided chambers, facilitate left heart filling, improve organ perfusion and reduce the likelihood of syncope, acute pulmonary hypertensive crisis and death. The systemic oxygen transport improves despite hypoxemia. Implantation is simple, feasible and safe, and the X-ray time and operation time are short. There is no severe complication or thrombosis during the mid-term follow-up of the clinical studies and the device remained patent. The syncope symptoms, six-minute walk distance, cardiac index and systemic oxygen transport improve significantly in the patients. ISD may be currently the last alternative treatment to improve symptoms and prolong survival in currently drug-resistant patients with severe PAH.
ObjectiveTo preliminarily explore the safety and efficacy of the Docs Valve transcatheter aortic valve replacement system. MethodsA total of 26 healthy adult sheep were selected and divided into an experimental group (n=18) and a control group (n=8). The experimental group underwent transcatheter aortic valve implantation (TAVI) via the transfemoral vascular approach, and were further subdivided into acute and chronic subgroups based on the timing of examination and anatomical exploration. Animals in the acute subgroup received anatomical exploration immediately postoperatively, while those in the chronic subgroup underwent the same exploration at 1, 3, and 6 months postoperatively. Valve position, paravalvular leak (PVL), and artificial valve leaflet tissue were observed at immediately post-operation (n=5), 1 month post-operation (n=2), 3 months post-operation (n=2), and 6 months post-operation (n=9). The control group received surgical replacement with a biological prosthetic valve, with corresponding examinations performed at 6 months postoperatively. The safety and efficacy of the valve system were analyzed using echocardiography, anatomical examination, and pathological examination. Results Seventeen sheep in the experimental group successfully completed TAVI, and 4 sheep in the control group successfully underwent surgical replacement, all surviving to the final observation period. During follow-up, valve morphology and position were normal, ultrasound imaging was clear, and the trends of changes in hemodynamics and left ventricular function were similar between the two groups. In the experimental group, 4 cases (4/17) of moderate paravalvular leakage occurred during follow-up; in the control group, 2 cases (2/4) of moderate paravalvular leakage and 1 case (1/4) of moderate regurgitation were noted. Anatomical examination revealed no thrombi, vegetations, or calcifications in either group; extensive endothelialization was observed on stents and valve leaflets, with a small amount of calcium deposition in the experimental group. Pathological examination showed no thrombus formation in core organs or brain tissues in either group. ConclusionThe results of this animal control trial preliminarily confirm the safety and efficacy of the Docs Valve transcatheter aortic valve replacement system. However, due to the limited sample size of the control group, the conclusions require further verification in larger sample sizes.
In recent years, with the continuous development and increasing maturity of interventional techniques, interventional treatment for congenital heart disease (CHD) has been progressively disseminated to county- and city-level hospitals in China. Concurrently, the standardized management of adult CHD (particularly patent foramen ovale) and the lifelong management of complex CHD are gaining increasing clinical attention, while the emergence of new techniques and products continuously advances the discipline. This article aims to review the new progress made in the field of interventional treatment for congenital heart disease in China during 2024. It specifically reviews and analyzes the following key aspects: (1) annual statistics on interventional closure procedures for CHD; (2) recent insights into patent foramen ovale closure; (3) advances in transcatheter pulmonary valve replacement; (4) interventional treatment and lifelong management strategies for complex CHD; (5) new interventional techniques for acquired heart disease; and (6) the application of artificial intelligence in CHD management. Through the synthesis and discussion of these topics, this article seeks to provide a detailed analysis of the current landscape of interventional treatment for CHD in China and project its future development trends.
Percutaneous ventricular assist device (PVAD) is a minimally invasive treatment which can replace the function of the failing heart. It provides circulatory support for patients with severe emergent cardiovascular diseases such as complex coronary artery disease, acute myocardial infarction complicated by cardiogenic shock, and acute decompensated chronic heart failure. PVAD has been developed since the rise of the Hemopump, to the prosperity of the Impella, and increasingly been used as a haemodynamic support to improve prognosis. This article will review the evolution and clinical application of PVAD.