Commentary | CMICS: The Leap and Rebalancing of Minimally Invasive Cardiovascular Surgery in China — A Structural Revolution

In the history of medicine, few specialties have undergone such a 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. This is a quiet yet profound revolution, a transformation reshaping the fates of patients nationwide.

On October 25, 2025, the China Minimally Invasive Cardiovascular Surgery Congress (CMICS) & International Minimally Invasive Cardiovascular Surgery Live Surgery Week Offline Conference was grandly held in Quanzhou, Fujian. At the conference, Professor Wang Chunsheng — Chairman of CMICS, Member of the National Cardiovascular Expert Committee, Director of the Minimally Invasive Cardiovascular Surgery Professional Committee, Director of the Department of Cardiac Surgery at Zhongshan Hospital Affiliated to Fudan University, and Director of the Shanghai Heart Valve Research Center — released the "2024 Statistical Data on Minimally Invasive Cardiac Surgeries by the National Minimally Invasive Cardiovascular Surgery Professional Committee (CMICS)". This article is based on CMICS’s statistical data on minimally invasive cardiac surgeries 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 a 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 shaping the landscape. Over six years, surgical concepts, regional patterns, hospital hierarchies, and even patient pathways have quietly changed, unfolding a cardiac surgery revolution from "centralization" to "balanced development".

Looking back to 2019, when CMICS first released national data in the form of an annual report, the key phrase was "rapid momentum"; by 2023, the wording in the report had shifted to "stable systems formed for various minimally invasive procedures." In just five years, minimally invasive cardiac surgery has moved from "innovative exploration" to "clinical normality."

Data speaks volumes. In 2023, the number of minimally invasive cardiovascular surgeries nationwide reached 98,401, a 39.8% increase from 2021; in 2024, it further climbed to 117,486, a year-on-year growth of 19.4%. Minimally invasive congenital heart defect correction under cardiopulmonary bypass increased by 22.8%, minimally invasive coronary artery bypass grafting (MICS-CABG) by 35.5%, and minimally invasive aortic surgeries by 42.3% — becoming the fastest-growing segment. Today, "achieving optimal efficacy with minimal trauma" has become a consensus in China’s cardiac surgery development, marking the transition of minimally invasive technology from an "option" to a "foundation".

2. Rebalancing of the Surgical Landscape

The 2024 "White Paper on Cardiovascular Surgery and Cardiopulmonary Bypass Data in China" shows that 789 hospitals nationwide performed 360,765 cardiac surgeries, with cardiopulmonary bypass accounting for 55.8% and off-pump procedures (including interventional and minimally invasive) reaching 44.2%. This marks 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 nationwide, with 80,016 cases (22.2%) and 92,488 cases (25.6%) respectively. However, minimally invasive surgery has the deepest penetration in these two segments. According to CMICS statistics, the number of minimally invasive valve and minimally invasive CABG surgeries nationwide approached 20,000 in 2023, accounting for over 20%. By 2024, this proportion further rose to 24%, indicating that "minimally invasive" is becoming an irreversible core component of China’s national cardiac surgery structure.

3. Regional Expansion and System Balance

Over the past decade, China’s cardiac surgery technology hubs were concentrated in Beijing, Shanghai, Wuhan, and Guangzhou. However, this pattern has been broken in the past three years. From 2023 to 2024, East China still led in total surgical volume, but North China and Central-South China recorded the fastest growth rates, with 48.6% and 30% year-on-year increases respectively; Northwest China’s minimally invasive CABG surged by 115.8%, ranking first nationwide. The top 10 provinces by surgical volume accounted for 68.1% of national cases, while the remaining one-third were distributed in hospitals in central, western, and prefecture-level cities. The opening of academic platforms, standardized training systems, and the maturity of domestic equipment have made "technology diffusion to grassroots" a replicable systemic achievement. This signifies that China’s cardiac surgery is evolving from "top-heavy centralization" to "networked balance".

4. Liaocheng Model: Grassroots Breakthrough and Replication

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

As a training center of Fuwai Hospital, National Center for Cardiovascular Diseases, the entire Liaocheng team has received systematic training, with core members further studying at the Cleveland Clinic, Mayo Clinic, and UCD Medical Center. Equipped with advanced equipment such as ECMO, intra-aortic balloon pump, cardiopulmonary bypass machine, and intraoperative transesophageal echocardiography, the hospital’s minimally invasive ratio in cardiac surgeries reaches 70%, and 90% for coronary artery bypass. They innovatively carry out totally thoracoscopic internal mammary artery harvesting, achieving smaller trauma and faster recovery, which has been learned and recognized by peers nationwide. More impressively, the out-of-pocket expenses for patients at this hospital are only one-third of those at top hospitals in Beijing and Shanghai, and the proportion of surgeries for elderly patients exceeds 50%, making it a regional cardiac treatment center covering western Shandong, southern Hebei, and northern Henan. The Liaocheng model proves that once technology is standardized, minimally invasive cardiac surgeries can be routinely and safely performed in county-level hospitals.

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

At the conference, Professor Wang Chunsheng presented data from the international STS Adult Cardiac Surgery Database. As of 2024, the annual volume of MICS-CABG and robotic CABG in the United States exceeded 1,000 and 1,500 cases respectively; minimally invasive mitral valve repair continued to rise, and TAVR surgeries surpassed 100,000 in 2023, becoming the dominant model for structural heart disease treatment. China’s growth rate is equally remarkable. In 2024, the national volume of MICS-CABG reached 5,063 cases, a year-on-year increase of 35.5%; minimally invasive valve surgeries hit 18,000 cases, up 18.3%; minimally invasive aortic surgeries reached 2,478 cases, a 42.3% year-on-year growth. This indicates that China’s minimally invasive surgery curve has synchronized with the international level, achieving "parallel acceleration" in growth rate.

6. Global New Technology Wave: China’s Synchronous Innovation

Globally in 2025, robot-assisted surgery, sutureless anastomosis systems, pure ultrasound navigation, and AI image assistance have become the direction of surgical innovation. In this global wave of innovation, China’s contributions are increasingly prominent. These technological breakthroughs mark the re-drawing of the "global innovation map" for minimally invasive cardiovascular surgery, with China evolving from a technology importer to an important participant in technology export and standard-setting. Meanwhile, Zhongshan Hospital Affiliated to Fudan University launched China’s first "physical heart valve disease center", indicating that China has entered the stage of systemic innovation beyond surgical technique innovation.

7. From Quantitative Growth to System Balance

China’s minimally invasive cardiovascular surgery has entered a stage of systematic development, where quality and innovation will become the core competitiveness in the next phase. Hospitals performing over 1,000 surgeries annually account for only 10.5% of the total, yet they complete 67.7% of national surgeries. With technological standardization and diffusion, more medium-sized hospitals have acquired high-level surgical capabilities, and the growth driver of China’s cardiac surgery is shifting from "quantitative centralization" to "qualitative diffusion".

Today, a three-level symbiotic system has taken shape nationwide: 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 Future of Cardiovascular Surgery in China

As we look ahead, the future of cardiovascular surgery in China appears promising. The advancements in minimally invasive techniques not only enhance patient outcomes but also reduce recovery times. This evolution signifies a shift toward more patient-centered care, where the focus is on achieving optimal results with minimal disruption to the patient's life.

The ongoing development of technology and training will continue to bridge the gap between urban and rural healthcare, ensuring that all patients have access to cutting-edge surgical options. The commitment to innovation and quality will drive the next phase of growth in this field, making China a leader in cardiovascular surgery on the global stage.

In conclusion, the transformation of cardiovascular surgery in China is a testament to the power of innovation and collaboration. The journey from concept to established practice reflects a dedication to improving patient care and outcomes, setting a standard for the future of medicine.

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