Embracing Challenges: The Right Attitude for Cardiothoracic Surgery Development and Talent Cultivation – Sun Lizhong
Cardiac surgery, regarded as the most challenging specialty, is typically the last discipline to be established in tertiary hospitals. Nevertheless, it serves as a vital “flagship” reflecting the level of medical expertise. It drives the overall development of related disciplines, significantly enhances regional healthcare capabilities, and reduces mortality rates among emergency patients with major cardiovascular diseases in the region.
On June 8, the National Center for Cardiovascular Diseases released the "Report on Cardiovascular Diseases in China 2018." The report indicates that the prevalence of cardiovascular diseases in China remains on the rise, with an estimated 290 million affected individuals. This includes 13 million stroke patients, 11 million patients with coronary heart disease, and 4.5 million patients with heart failure. The average age of patients undergoing coronary stent implantation in China is 62 years. Deaths attributable to cardiovascular diseases account for more than 40% of all disease-related deaths among residents, ranking first among all causes of death.
However, the current capacity of cardiac surgery services in China is insufficient to meet the potential demand for tens of millions of procedures.Currently, China’s cardiac surgery sector is experiencing severe “polarization.” Approximately 722 tertiary hospitals are capable of performing cardiac surgical procedures, among which only slightly more than 20 conduct over 1,000 surgeries annually, mostly concentrated in major cities such as Beijing, Shanghai, Guangzhou, and Wuhan. Fewer than 100 hospitals perform at least 300 such procedures per year, while as many as 1,473 tertiary hospitals have yet to establish cardiac surgery departments.
Data Source: 2017 White Paper on Cardiac Surgery and Cardiopulmonary Bypass Data in China
Due to the high surgical risks and demanding technical requirements, performing cardiac surgery is something many hospital directors at prefecture-level and county-level hospitals would not even dare to consider.
To promote the rapid and healthy development of cardiac surgery in China, Director Sun Lizhong proposed a dual-pronged approach: on one hand, providing support to grassroots institutions by strengthening cardiac surgery departments in Grade 3A hospitals across second- and third-tier cities; on the other hand, advancing top-tier scientific research and innovation. He emphasized encouraging and supporting the research and development of innovative medical devices, noting that innovations from individual enterprises often drive progress across the entire discipline and surgical techniques, thereby saving more patients.
In promoting the development of cardiac surgery in China, Director Sun Lizhong and his team of experts in heart and great vessels have made significant efforts. VCBeat interviewedDirector Sun Lizhong(Chairman-Elect of the Chinese Society of Cardiothoracic Surgery, Chairman of the Cardiac Surgery Committee of the China Medicine Education Association, Chairman of the Cardiovascular Surgery Technology and Engineering Branch of the China Medical Biotechnology Association, Director of the Center for Cardiac Surgery at Anzhen Hospital),Director Zheng Jun(Deputy Chairman and Secretary-General of the Cardiac Surgery Professional Committee of the Chinese Medical Education Association) andDirector Xu Shangdong(Secretary-General of the Cardiovascular Surgery Technology and Engineering Branch of the Chinese Medical Biotechnology Association) Understanding how cardiovascular surgery in China can achieve healthy and sustainable development.
Sun Lizhong
Incoming Chairman of the Chinese Society of Thoracic and Cardiovascular Surgery, Chinese Medical Association; Chairman of the Cardiac Surgery Professional Committee, China Medicine Education Association; Chairman of the Cardiovascular Surgery Technology and Engineering Branch, China Medical Biotechnology Association; Director of the Center for Cardiac Surgery, Beijing Anzhen Hospital
Building a cardiac surgery department is a tough nut for hospitals to crack.First, the training period for cardiac surgeons is lengthy, and surgical technique is paramount. Progressing from imitation to simulation and ultimately to mastering the essence of the craft, a lead cardiac surgeon typically requires a training period of 10 years or more.。
Secondly, cardiac surgery demands an exceptionally high level of teamwork. Unlike other surgical specialties, cardiac procedures induce changes in circulatory status during the operation. Successful completion requires close coordination among anesthesiologists, perfusionists, and surgeons. Furthermore, postoperative care by intensive care unit (ICU) physicians is essential to ensure patient recovery.
Finally, the high cost of departmental development is reflected in two aspects: team building and hardware costs.。
Director Sun Lizhong told VCBeat that the development of cardiac surgery departments involves a long construction cycle, challenges in talent cultivation, and high surgical risks. The reason many hospital presidents have made the determined commitment to establish cardiac surgery departments is, on one hand, due to the substantial patient demand in China,On the other hand, the development of a cardiac surgery department will drive improvements in the overall surgical capabilities of the hospital. This specialty places high demands on professionals in anesthesiology, extracorporeal circulation, nursing, and intensive care units (ICU), thereby fostering advancement across many departments within the institution. Furthermore, establishing an excellent cardiac surgery team significantly enhances the hospital’s competitiveness, brand reputation, and research capabilities.。
Director Xu Shangdong stated that due to the prolonged training period and demanding nature of cardiac surgery, many young physicians are reluctant to enter this field, and the insufficient pipeline of talent is a significant factor constraining the development of cardiac surgery. Meanwhile, given the high clinical risks associated with cardiac surgery, many hospitals have not prioritized the development of their cardiac surgery departments.
Director Zheng Jun stated that to develop cardiac surgery, the hospital must first make a firm decision to pursue it, much like entrepreneurship: for a company to survive, its founders must be resolute. Additionally, without early support, it is difficult for the specialty to grow. In the early stages, when the department lacks both technical expertise and experience, relying solely on internal accumulation often proves insufficient; many hospitals struggle to persist for over a decade before ultimately giving up.
The development of cardiac surgery departments follows a systematic methodology.
The Cardiac Surgery Professional Committee of the Chinese Medical Education Association has developed the Cardiac Surgery Revitalization Plan (Systematic Project for the Standardized Development of Cardiac Surgery in China).Design distinct development and support plans for hospitals with no foundational capabilities and those with an existing basis in cardiac surgery.
For Hospitals Without Established Cardiac Surgery DepartmentsFor example, at Sichuan Science City Hospital, after thorough communication between the project expert panel and the hospital administration, a detailed plan for discipline construction and development pathways was formulated. In terms of talent development, the hospital organized a 16-member team to undergo one year of advanced training; this team included cardiac surgeons, anesthesiologists, perfusionists, ICU physicians, operating room nurses, and ward nurses. Regarding hardware configuration, the project expert panel provided a comprehensive supporting solution, fulfilling all hardware requirements within just six months, thereby significantly saving time and financial costs.
The Department of Cardiac Surgery at Science City Hospital was established in just six months, from planning to completion. Initially, the project team dispatched experts to perform surgeries at Science City Hospital. During the preparation and execution of these procedures, the experts also served as instructors, providing ongoing training to the department’s staff.
The department was established just over a year ago and has already completed nearly 120 surgeries. The scope of procedures covers almost all types of cardiac surgical operations, with many cases matching the complexity level of those performed at Beijing Anzhen Hospital. Furthermore, the hospital undertakes certain cardiac surgical cases from Sichuan Province, which is a remarkable achievement for a newly established cardiac surgery department.。
For hospitals with an established foundation,For example, the People’s Hospital of Ningxia Hui Autonomous Region has established a certain foundation in cardiac surgery. Based on the hospital’s characteristics and disciplinary strengths, the Special Committee formulated a development strategy and a three-year plan featuring aortic diseases as its specialty. Prior to the project’s implementation, the majority of local aortic surgeries had to be referred to Beijing or other regions, often causing emergency patients to miss critical windows for treatment. Currently, aortic disease patients from throughout Ningxia and its surrounding areas are routinely referred directly to the People’s Hospital of Ningxia Hui Autonomous Region for care.
Bolstered by its reputation in the management of aortic diseases, the department has progressively expanded its influence within the medical community and society at large. The number of cardiac surgical procedures performed at the hospital has increased from approximately several dozen cases per year prior to the assistance program to over 270 cases currently.。
Although the assistance program has proven highly effective, the limited availability of our project team’s experts meant that, in the past, we could only support three hospitals per year—a satisfactory outcome given our capacity. Starting this year, dozens of experts across China have volunteered to serve as mentors for this initiative, contributing to disciplinary development. As a result, the implementation of the project will be significantly accelerated.
Although the development of cardiac surgery is challenging, there are many cases of rapid growth. For example, Xijing Hospital has carved out its own development model.
Xijing Hospital’s Department of Cardiovascular Surgery has subdivided its specialty into distinct segments, with each team member responsible for a specific area and dedicated to surgical procedures and research within that domain. This approach compels individuals to develop into true experts. Simultaneously, the hospital has concentrated its resources to achieve breakthroughs in each subspecialty one by one. As a result, after decades of development, the clinical volume of Xijing Hospital’s Department of Cardiovascular Surgery has grown rapidly.。
The “2017 White Paper on Cardiovascular Surgery and Cardiopulmonary Bypass Data in China” shows that Xijing Hospital performed 4,882 cardiovascular surgeries and 2,797 cardiopulmonary bypass procedures, ranking fourth and ninth nationwide, respectively.
Another typical case is Wuhan Asia Heart Hospital. Xie Junming, Chairman of Wuhan Asia Industrial Co., Ltd., stated in 2016: “Wuhan Asia Heart Hospital was officially established on November 11, 1999. Since its establishment, the hospital’s annual volume of cardiac surgical procedures has ranked among the top three nationwide for ten consecutive years, with a surgical success rate of 98%. Its annual volume of cardiac interventional procedures has ranked among the top ten nationwide for eleven consecutive years, with a success rate of 98.06%. It took Wuhan Asia Heart Hospital 17 years to achieve these accomplishments in the treatment of heart disease.”
Director Zheng Jun stated that the successful experience of Wuhan Asia Heart Hospital is worth learning from and reflecting upon for all directors of cardiac surgery departments, physicians, and many presidents of Grade 3A hospitals. To build a strong department, in addition to technical expertise, hospital administrators must adopt a management-oriented mindset to expand and strengthen the team. At the 2019 China Cardiac Surgery Frontier Technology Forum, we will invite numerous such experts to share their experiences with peers.
Cardiac surgery has a relatively short history, having only emerged in the 1950s. The United States has consistently led the latest developments in this specialty. In recent years, with deepening international exchanges and the rapid dissemination of new technologies, the gap between China and the United States has become minimal. Many advanced medical devices and surgical techniques are quickly introduced into China. Moreover, due to the large patient population in China, Chinese physicians accumulate more extensive clinical experience.
Director Xu Shangdong stated that, in terms of organizational structure, the U.S. model of physician groups offers valuable lessons for us to learn from. Cardiac surgery demands a high level of physician experience; although many hospitals currently have cardiac surgery departments, most perform fewer than 300 procedures annually. From the patient’s perspective, there is a strong preference for surgeries to be performed by experienced surgeons. Therefore, physician groups composed of outstanding cardiac surgeons would be welcomed by all stakeholders.
Moreover, the multi-site practice of outstanding cardiac surgeons can disseminate their valuable experience and knowledge.。
In terms of talent development, there is still a significant gap between China and foreign countries, particularly in the lack ofTalent Assessment and Traceability System. In the United States, hospitals that recruit resident physicians receive government subsidies, and during the training period, the hospital assumes responsibility for the surgeries performed by these physicians.
Upon graduation, physicians receive a certificate from the hospital certifying their competence to perform cardiac surgical procedures. When these physicians join other institutions, those employers provide performance evaluations; unfavorable reviews can adversely affect the hospital’s future student recruitment efforts and may even result in the revocation of its accreditation to enroll students.
In China, master’s and doctoral programs in cardiac surgery tend to prioritize research over clinical practice, meaning that surgical proficiency requires considerable additional time to develop. This model of talent cultivation and evaluation warrants careful reflection. While the United States also has physicians who focus primarily on research and publishing, they account for only 5%–10% of the profession; the majority of trainees devote their efforts to clinical work.
The road ahead is long and arduous! There is still a long way to go in the development of cardiac surgery, but fortunately, we have pioneers to lead the way.
Advances in clinical surgery are often accompanied by advances in instruments or consumables.
Therefore, cardiac surgery must advance,Inseparable from multi-party collaboration among industry, academia, and research“Doctors must first shift their role perception; the realization of personal value lies not only in treating diseases and saving lives, but also in leaving behind valuable medical products for future generations through collaborative research,” said Xu Shangdong.
Corporate R&D personnel and physicians each have their own areas of expertise. Those who understand healthcare, are capable of R&D, and can alsoAwareness and RefinementThe clinical demand is very low.
Therefore, under normal circumstances, each party should leverage its respective strengths.
The prevailing model typically involves enterprises first designing and developing a product, then presenting prototypes to physicians to assess how well they meet clinical needs. Conversely, when physicians have ideas in their daily practice, they often design and develop preliminary concepts themselves before seeking collaboration with companies.
Under the current model, both enterprises and physicians are engaged in many tasks outside their areas of expertise. The correct approach to collaboration should leverage each party’s strengths: physicians articulate needs, enterprises develop designs, physicians provide feedback for revisions, and both parties work together to continuously refine the solution.
“The standard R&D process should involve enterprises designing products that address clinical needs in collaboration with physicians. While this sounds straightforward, it has not been well implemented in China.“This is also why we brought relevant industries together for the 2019 China Cardiac Surgery Frontier Technology Forum in November, with the hope that all parties could sit down to communicate and discuss models for collaboration,” stated Director Zheng Jun.
For instance, the team led by Director Sun Lizhong at Beijing Anzhen Hospital has a widely recognized innovation—the “Sun’s Procedure.” Based on the morphological characteristics of aortic diseases in China, this approach utilizes a self-developed stented graft to establish and apply a novel technique for aortic arch replacement combined with the stented elephant trunk procedure.
The success of the Sun’s procedure is attributed to a major material innovation: the independently developed stent graft. This material was designed based on clinical needs to assist surgeons in performing the intended procedure. Following its introduction, it yielded excellent surgical outcomes. Subsequent extensive case studies facilitated the establishment of the “Sun’s procedure” and promoted the innovative application of this new material, representing a typical success story.
Therefore, the design of new materials must be driven by clinical needs to identify key breakthroughs. Once successful cases are established, subsequent case studies will give rise to numerous product-related insights, continuously facilitating product optimization and ultimately enabling broader market adoption.
With companies being a mixed bag, Director Sun Lizhong offers the following advice for physicians when selecting partners:First, it is essential to identify enterprises that are visionary and committed to long-term research and development in the cardiovascular field. If the intention is merely a short-term, one-off collaboration aimed at immediate profit, then such a partnership is not worthwhile. Additionally, it is important to select companies with substantial capabilities. Before entering into a collaboration, physicians should review the company’s research focus and track record of past achievements, as these are key indicators for assessing the reliability of a potential partner.
Areas to Watch in the Future of Cardiac Surgery, Director Zheng Jun believes that there are two areas worth paying attention to:One is to develop more minimally invasive approaches for existing treatment regimens. The other is to treat currently untreatable patients through innovative therapies.. For instance, with transcatheter heart valves, patients previously required open-heart surgery, which is highly invasive and carries significant risks, making it unsuitable for many elderly individuals. The advent of transcatheter valves has enabled minimally invasive procedures that can rapidly address the issue and improve patients’ quality of life.
In addition, cardiac assist devices, including artificial hearts, are used for patients with severe heart failure. Before these products were available, patients could only be maintained on medication. With the use of an artificial heart, the patient’s own heart can rest, improving circulatory function and creating a window of time to wait for a donor organ, given that donors for heart transplantation are limited.
Regarding this issue, Director Xu Shangdong provided the same answer, also believing that interventional therapy, with its minimal trauma and short operation time, is the trend, and that artificial hearts will be an important direction for future development.
To promote the continuous development of cardiac surgery in China and foster innovative integration among industry, academia, research, and clinical practice, the “FTC2019 1st China Frontier Technologies Forum in Cardiac Surgery” will be held in Beijing on November 9–10, 2019.
FTC2019 China Frontier Technologies Forum in Cardiac Surgery
Organized by the Cardiac Surgery Professional Committee of the China Medical Education Association and the Cardiovascular Surgery Technology and Engineering Branch of the China Medicine Biotechnology Association, co-organized by Da Yisheng Bingqi Pu, and undertaken by VCBeat, this forum will invite government representatives, over 100 industry guests, and more than 500 physicians and experts. Participants will engage in discussions on the innovation and application of cardiac surgery technologies, focusing on four key areas: policy guidance, technological innovation, discipline development, and industrial collaboration. The forum will release the "2019 Report on Innovative Practices in Cardiac Surgery Technology in China" and the "Expert Consensus on Surgical Procedures for Aortic Surgery." It aims to comprehensively analyze the current status and challenges of cardiac surgery in China, promote technological innovation and development in the field, unite forces across the industry chain, and better serve patients with heart disease.
Forum Official Website Link:https://vcbeat.top/FTC2019
Scan the QR code to register on Huodongxing
As a concurrent event of the conference, from August 12 to September 27, the Cardiac Surgery Professional Committee of the China Medical Education Association, the Cardiac Surgery Professional Committee of the China Medicine Biotechnology Engineering Association, and VCBeat jointly launched“Starting from the Heart—Call for Entries: Top 10 Innovative Cases in Cardiac Surgery Technology in China, 2019”This initiative, open to medical institutions at all levels and enterprises in the medical device, pharmaceutical, and healthcare service sectors, broadly solicits case studies of technological innovations in cardiac surgery. It conducts in-depth analyses of the methodologies, pathways, and outcomes associated with these cases, summarizes best practices, and provides references to promote scientific and technological innovation in medicine, improve healthcare quality, safety, and efficiency, and advance technical standards in cardiac surgery.
Call for Entries: Top 10 Innovations in Cardiac Surgery Technology in China, 2019
Outstanding cases will have the opportunity to be invited to the FTC 2019 China Frontier Technologies in Cardiac Surgery Forum and enjoy various other benefits, while also receiving direct feedback from the expert review panel.
A panel of 30 academic and industry experts, jointly selected by the Cardiac Surgery Professional Committee of the China Medical Education Association, the Cardiac Surgery Professional Committee of the Chinese Society of Biomedical Engineering, and VCBeat Research Institute, was formed to evaluate cases across three dimensions: innovation, value, and academic translation/industrialization, focusing on key technologies, outcomes, and applications. The confirmed review experts are as follows:
Registration Link:http://vcbeat2018.mikecrm.com/o3ce6wI
Scan the QR code to register