Professor Gao Yongshun's Innovative Single-Stage Surgical Approach for Post-Cardiac Surgery Sternal Infection Treatment Featured in Prospectus

“From 1990 to 2016, there was a significant improvement in healthcare accessibility and quality in China.” On August 5, 2018, at the closing ceremony of the Chinese Cardiac Conference, Academician Hu Shoushou, Director of the National Center for Cardiovascular Diseases and President of Fuwai Hospital, stated, “Over the past decade, the annual volume of cardiac surgeries in China has increased from 80,000 to 210,000 cases. There has been remarkable progress in coronary artery bypass grafting (CABG) capabilities at 77 major hospitals, with the in-hospital mortality rate for CABG patients dropping to 2.2%.”

The development of cardiac surgery in China has been flourishing; however, we must not become complacent. Many postoperative complications still require urgent attention, such as sternal wound infections. Sternal wound infections not only cause significant physical suffering to patients but also pose a risk of mortality. Furthermore, they impose a substantial financial burden on patients.

Fuwai Hospital of Cardiovascular Diseases, Chinese Academy of Medical Sciences, summarized 139 cases of sternal infection occurring in adult cardiac surgeries over a three-year period, with a mortality rate of 9.4%. According to a paper published by Professor Gao Yongshun, the incidence of sternal infection ranges from 0.5% to 2.2%.

Professor Gao Yongshun is an expert in the field of cardiothoracic surgery. He formerly served as Chief Physician of the Department of Cardiothoracic Surgery at the Chinese PLA General Hospital. With over 40 years of experience in cardiothoracic surgery, he has spearheaded the establishment and development of cardiac surgery specialties at numerous hospitals. Professor Gao stated, “Sternal wound infection following cardiac surgery is a severe complication that can be life-threatening and poses significant management challenges.”

In fact, sternal infections can be cured in a single intervention if properly managed. The approach and concept of achieving definitive cure of infected wounds through a one-stage surgical procedure were first proposed and practiced by Professor Gao Yongshun.

Professor Gao Yongshun’s proprietary single-procedure surgical method for curing infected wounds has been in clinical use for 27 years and is currently applied in more than 200 hospitals across China. Over these 27 years, Professor Gao has treated over 2,000 patients with sternal infections, a number that continues to rise.

How Can Infected Wounds Be Cured in a Single Surgical Procedure? What Are the Advantages of This Surgical Approach? To Find Out, VCBeat Conducted an Exclusive Interview with Professor Gao Yongshun.

VCBeat: Why did you choose post-cardiac surgery sternal infection as your research focus?

Gao Yongshun: Sternal infections are difficult to treat, pose severe health risks, and carry a high mortality rate. Although the incidence of sternal infection is low, there are still many such patients in clinical practice. Traditional treatment methods have yielded suboptimal outcomes; many patients have undergone ineffective treatments, incurred unnecessary expenses, and still failed to achieve cure.

This situation has further strained the doctor-patient relationship, with some past conflicts arising from ineffective or suboptimal treatment outcomes in patients with sternal infections. I am committed to addressing the challenge of sternal infections to help alleviate patients’ suffering.

VCBeat: You have previously proposed the concept of "futile care." Could you please elaborate on it?

Gao Yongshun: Ineffective treatment refers to the scenario where, following the onset of sternal infection, the therapeutic methods employed fail to heal the wound and instead prolong the disease course; treatment administered during this period is considered ineffective.

Ineffective treatment can cause losses (economic and safety-related) to patients during the course of therapy, expose them to risks, and even result in loss of life. This is also an inevitable consequence of inappropriate selection of therapeutic measures.

Potential risks of wound infection include various complications and unforeseen events that may arise during treatment; the longer healing is delayed, the greater the risk and the more severe the resulting problems. Early resolution of infected wounds is the most effective measure to prevent and avoid these issues.

VCBeat: What are your methods and philosophy for curing sternal infections with a single surgery?

Gao Yongshun: The surgical approach for the one-time cure of sternal infection involves converting the infected wound into a sterile wound through surgical techniques, followed by pectoralis major muscle flap transfer to repair the residual cavity. A specialized suturing technique is employed to ensure no foreign bodies remain within the wound, thereby achieving primary healing.

This surgical procedure is suitable for wound infections at any stage following cardiac surgery. Early intervention can prevent further complications and reduce the pain, risks, and treatment costs associated with ineffective therapies.

Using a one-time surgical cure method, the patient's cure rate within 2 weeks reaches over 90%, and the results are reproducible. I have implemented this approach in more than 200 hospitals across China and promoted the concept of curing infected wounds with a single surgery. If cardiac surgeons adopt this concept, cases of prolonged non-healing sternal infections or severe complications due to long-term treatment leading to patient death can also be avoided.

In cases where drugs are ineffective against extensively drug-resistant bacteria, the surgical removal of pathogens confined to infected tissues constitutes the theoretical basis for achieving primary cure of infected wounds. If this concept can be recognized by colleagues in the surgical community,Applicable to the treatment of infected wounds at any anatomical site, which has certain reference value for surgical therapeutics.

VCBeat: What prompted you to perform your first surgery for sternal infection?

Gao Yongshun: It was a coincidence. In 1992, I was pursuing advanced studies at Fuwai Hospital. At that time, a female patient from Wuhan had undergone heart valve replacement surgery and had been hospitalized for seven months due to infection. It was during the Spring Festival; she was in low spirits and had suicidal thoughts.

It happened to be my turn to change her dressing. Noticing her emotional distress, I offered comfort and reassurance. Offhandedly, I mentioned that surgical intervention might lead to a faster recovery in her case. She clung to this suggestion as if it were a lifeline, insisting on undergoing the surgery.

Having previously treated osteomyelitis and gained experience in medical aesthetics and plastic surgery, I successfully completed the procedure by drawing on this expertise. The outcome was excellent, and she was discharged just two weeks later. Even Fuwai Hospital was astonished, having not expected that a patient with such a severe condition could be cured within two weeks. Since then, the number of such surgeries has gradually increased, and I have been sharing these techniques and concepts with hospitals across China to benefit more patients.

VCBeat: Among the methods for treating sternal infections both domestically and internationally, what are the distinctive features of your approach?

Gao Yongshun: First, I pioneered the method of curing sternal infection in a single surgical procedure. Second, this surgical technique can achieve a cure in one operation.

Currently, the treatment of infections both domestically and internationally remains quite traditional. Most physicians still rely on surgical debridement. Although this technique has a history of one to two hundred years, its efficacy in managing infected wounds is far from ideal. Many patients’ acute infected wounds progress to chronic states without being eradicated; while some cases can be cured, they require multiple treatment sessions.

In contrast, the single-stage surgical approach for curing sternal infections can eradicate infected wounds with just one operation, allowing most patients to be discharged within two weeks.

The one-time surgical cure for sternal infection addresses the clinical challenge of treating infected wounds that are difficult to heal, alleviating suffering for many patients with chronic non-healing conditions and saving the lives of numerous critically ill patients.

Achieving primary healing of infected wounds in a single surgical procedure is an innovation that rewrites the conventional contraindication to suturing infected wounds as stated in medical textbooks. To date, there are no established methods abroad for achieving short-term, one-stage cure of infected wounds. Therefore, this technique holds significant reference value for clinical surgical practice.

VCBeat: What do you consider to be the standards for treating infections?

Gao Yongshun: Sternal infection is a complication, distinct from the primary disease. The treatment of the primary disease can generally be managed by the corresponding specialty departments, following standardized treatment pathways and criteria. In contrast, the management of complications differs, requiring clinical judgment by the attending physician, with various therapeutic approaches available, each leading to different outcomes. Regarding sternal infection, I believe several criteria can serve as references:

Treatment of sternal infection should not result in patient mortality;

Infected wounds should heal within two months;

The cost of treating sternal infections should not exceed that of cardiac surgery.

I pioneered a single-procedure surgical approach to cure sternal infections, achieving complete resolution in just one operation. I hope to promote this technique to benefit more patients. Widespread adoption would reduce healthcare costs for patients, alleviate doctor-patient conflicts, enhance professional recognition for physicians, and prevent the waste of hospital medical resources.

VCBeat: What measures have you taken to promote this concept?

Gao Yongshun: In 2018, I organized a training course on the surgical management of sternal infections. During the course, I emphasized the importance of treating sternal infections and demonstrated a single-stage surgical approach for curing sternal infections. The procedure was also broadcast via live streaming to reach a wider audience of physicians. I recorded the surgical procedure as a video and uploaded it to a website, allowing trainees to review it repeatedly and facilitating its dissemination to more doctors.

I also travel across China to teach these surgical techniques and concepts at hospitals. More than 200 hospitals, including Beijing Fuwai Hospital, Beijing Anzhen Hospital, Peking University People’s Hospital, and Xiangya Hospital in Hunan, have already adopted this surgical approach. In terms of surgical practice, I encourage physicians to gain more hands-on experience. Cultivating a large pool of skilled professionals will ultimately benefit patients and support physicians’ professional development.

Additionally, I have established two sternal infection treatment centers at the Department of Cardiovascular Surgery of the General Hospital of the Chinese People's Liberation Army and at the Beijing Chaoyang Hospital Center for Emergency Rescue with Integrated Traditional Chinese and Western Medicine, to treat patients with sternal infections.

In 2018, Professor Gao Yongshun performed 350 surgeries, and this year he is expected to perform more than 400. To date, Professor Gao has performed over 2,000 surgeries achieving one-time cure for sternal infections, and this number continues to rise.

What he hopes for is that more doctors will master this surgical technique and embrace the concept of achieving a cure with a single procedure, thereby enabling more patients to benefit.