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The Cardiac Center at the Zhongshan Hospital

 

The Cardiac Surgery Center at Shanghai Zhongshan Hospital is part of Shanghai Cardiovascular Diseases Research Institute, which was designated by the WHO (World Health Organization) as cardiovascular research and training center in 1980. This institute houses the cardiac surgery center (including two cardiac surgery units and one ICU), interventional cardiology, noninvasive cardiac imaging, ECG, the cardiomyopathy research lab (supported by the Chinese Ministry of Health), the central lab, and other units. The cardiovascular diseases research institute has a ten-floor-building that is 8442 square meters in area, with 221 beds and state-of-art equipments.

The department of cardiac surgery was created in 1947 by Dr. Jia-Si Huang, a founder of cardiothoracic surgery in China recognized as one of the 229 members of Founder’s Group of the American Board of Thoracic Surgery. The first Chinese made heart-lung machine was built and used in this hospital. There are two professors, five associate professors, and twelve attendings covering 87 ward beds, 18 ICU beds, and 2 heart transplant beds. They perform over 1000 surgeries annually with the success rate of 98%.

As the nation's leading hospital, the department of cardiac surgery has been and continues to be at the forefront of medicine, being the first in the country to utilize the da Vinci robotic system during heart surgery and an active center of using bone marrow transplant to treat heart failure post MI. They have completed 20 cases of roboticly assisted CABG (all succeeded), many cases of MIDCAB (Minimally Invasive Direct Coronary Artery Bypass), coronary artery reconstruction using tissue engineering technique, and CABG plus myocardium reconstruction using the skeletal muscle flap on patients with large area of dead myocardium (mortality 10%, 1-year survival 70%,  cardiac function improvement 80%). Since 1999, they have completed over 1500 cases of CABG, 50% of which was high-risk coronary revascularization. The off-pump rate is 100% for those who need CABG only with mortality of 0.5%, which is less than 3% by the American Society of Thoracic Surgeons. The perioperative morbidity is 0.5-1.0%. For patients younger than 60, they use arterial graft instead of venous graft, which has improved the long-term effect and reduced the need for the procedure again. The mortality of high-risk revascularization (the eldest was 85 y/o, 50% had history of MI, and 30% has Ef <30%) is 5%, the best in China.

They are among the earliest to perform aortic aneurysm repair and aortic dissection repair. In recent years, they have completed over 110 cases of Bentall procedure with a success rate above 95%, and no mortality over more than 40 consecutive cases. In addition, they have done many total aortic arch replacement and elephant trunk procedures with good short and long term effect as well as 20 more cases of descending aortic aneurysm repair plus many emergent aortic dissection repairs. 

The department is also the home of Valve Research Center, which pioneers in conducing research on native and prosthetic valves as well as developing new valves.  For example, their research on hemodynemics across native valves and replacement valves found that the configuration of the ring of native mitral valve does not stay constant; rather it changes during a cardiac cycle. This discovery led to the production of the prosthetic mitral valve with a soft ring. Since then this type of valve has been widely used and generated improved clinical outcomes. The Ministry of Health awarded the department with the Second Degree Scientific Research Award.  The development of the non-stent valve for patients with small aortic valves has achieved better clinical outcomes than the stent prosthetic valves. They perform approximately 800 cases of valve replacement annually. Now they are conducting research on tissue engineering to produce tissue engineered valve.

For the last two and half years, they have performed 60 heart transplants. All patients have been discharged and most of them have returned to work. The longest ischemic time is 4.5 hours. Now they are conducting research on preserving donated hearts and suppressing rejections on transplanted hearts by genetically switching leukotrienes in partnership with American University of California.

As a bridge to heart transplantation or alternatives in some cases, they use ventricular assist device implantation (Thoratac, Norvaco, Heartmate) on those with acute or chronic intractable heart failure due to varieties of heart disorders. For patients with difficult-to-treat low output syndromes post-operatively, 25-50% of them survived without having to take further steps. In acute myocardial infarction, 98% past the acute phase and 30% recovered on its own. They also implant ventricular assist device on patients with long term congestive heart failure with 90% of discharge rate and 50-80% of long-term survival.

Some patients have enlarged left ventricle due to long term diseases. They treat them with left ventricular reduction surgery to reduce the size of the enlarged heart muscle so the heart can pump more efficiently and vigorously. The mortality of this type of surgery is 1.9%; and the 1-year survival is 87%. 72% of these patients have avoided having heart transplant.

For patients with chronic atria fibrillation, they treat it with microwave ablation during the surgery and have achieved promising outcomes.

The hospital regularly sends surgeons to Germany and America to receive clinical training on advanced procedures. They also invite cardiac surgeons from abroad to come to the Zhongshan Hospital to exchange experiences. Many surgeons attend medical conferences abroad to catch up on new developments in cardiothoracic surgery. Embraced by the academic and professional atmosphere, they make up one of the strongest cardiac surgical teams in China. They have been recognized for their excellence with many awards.


 
 
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