China vs. U.S.: How Does China's Cardiovascular Surgery Technology Compare?

Shanghai, 2025. In the catheterization lab of Zhongshan Hospital's Cardiology Department, 68-year-old Ms. Zhang is wheeled into the operating room for an acute myocardial infarction. Lead surgeon Dr. Wang deftly maneuvers a biodegradable stent just 1.8 millimeters in diameter. Guided by real-time imaging from the angiography machine, he precisely delivers it into the narrowed left anterior descending artery—the entire procedure completed in just 47 minutes. At the same moment, in the catheterization lab at NewYork-Presbyterian Hospital, 72-year-old John undergoes TAVR (Transcatheter Aortic Valve Replacement) for the same condition. Surgeon James completes the minimally invasive procedure using the latest Evolut PRO+ valve system in 52 minutes. The patient regains consciousness immediately post-surgery and is already able to eat independently.

These two scenarios reflect the true landscape of cardiovascular surgical techniques in China and the United States: China has accumulated “quantitative depth” through the world's largest volume of surgeries, while the United States continues to lead in “qualitative excellence” through sustained innovation. As a cardiac surgeon who worked at Johns Hopkins Hospital in the U.S. for 15 years and has frequently participated in Sino-American academic exchanges in recent years, I aim to reconstruct this technical dialogue—one without a clear “winner”—from three dimensions: technical details, clinical practice, and systemic differences.

I. Technical Pathways: The Divide Between “Maturity” and “Cutting-Edge”

The core battlefield of cardiovascular surgery has always revolved around “how to save myocardial tissue with less trauma, greater precision, and higher efficiency.” In this dimension, China and the United States exhibit distinct phases of development.

China leads globally in the “widespread adoption of mature technologies.” Take percutaneous coronary intervention (PCI) for coronary heart disease as an example: China performs over 1.5 million PCI procedures annually (2024 data from the National Center for Cardiovascular Diseases), accounting for 38% of the global total. The procedure's success rate remains consistently above 99%, with a complication rate of less than 2%. This “volume” advantage stems from three key pillars:

• Primary Care Penetration: China's nationwide network of “Chest Pain Centers” (over 5,000 certified facilities) has reduced the “door-to-balloon time” (time from admission to balloon expansion) for emergency PCI to an average of 72 minutes (with some top hospitals achieving under 50 minutes), far surpassing the U.S. average of 89 minutes (JACC data). The proportion of PCI procedures performed at county-level hospitals has risen from 12% in 2015 to 35% in 2024, ensuring rural patients also receive timely treatment.

• Device localization: Domestic stents (e.g., MicroPort, Lepu) now hold an 82% market share, priced at one-third to one-half of imported products. Through the “Special Review for Innovative Medical Devices” pathway, new products like biodegradable stents and drug-coated balloons iterate at the same pace as the U.S. (some even adopted for trials in Europe and America due to better alignment with Asian vascular characteristics).

• Physician Experience: Chinese interventional cardiologists typically perform 200-500 procedures annually (compared to an average of 150 in the U.S.), gaining richer expertise in managing complex lesions like left main bifurcation and chronic total occlusion. A 2024 comparative study in Circulation revealed Chinese physicians achieve a 92% success rate in chronic total occlusion (CTO) revascularization—on par with top U.S. centers.

In contrast, the United States retains a first-mover advantage in pioneering and applying cutting-edge technologies. In the field of structural heart disease, the U.S. is the birthplace of technologies such as TAVR, mitral valve repair (MitraClip), and left atrial appendage closure (LAAC):

• For TAVR, the U.S. FDA approved the first balloon-expandable valve (Edwards SAPIEN) as early as 2011, nearly eight years ahead of China; The newly approved Evolut PRO+ system in 2025, featuring a “self-expanding + annuloplasty” design, expanded surgical indications from high-risk patients to moderate-risk and even some low-risk populations. Global cumulative implants exceed 2 million cases (with the U.S. accounting for 45%).

• In minimally invasive cardiac surgery, robotic systems (e.g., Da Vinci Xi) account for 18% of cardiac procedures in the U.S. (2024 STS data), compared to only about 5% in China. The more advanced “transcatheter mitral valve replacement” (TMVR) has surpassed 50,000 cases globally, while China remains in the clinical trial phase.

• The depth of AI application warrants greater attention: U.S. AI preoperative planning systems (e.g., HeartFlow) now cover 90% of complex coronary artery bypass grafting procedures. By predicting stent outcomes through CT angiography reconstruction, they reduce surgical planning time from one hour to 15 minutes. While China is catching up (e.g., Infervision's coronary AI analysis), it still lags in both the volume of pathological model training data (the U.S. possesses the world's largest cardiovascular imaging database) and algorithm iteration speed.

II. Clinical Practice: Differentiated Choices Driven by “Patient Needs”

Technology itself has no inherent superiority, but differences in application scenarios have led Chinese and American physicians to develop complementary approaches to “technology selection.”

Chinese physicians' pragmatic orientation stems from a massive patient population and limited healthcare resources. For instance, when treating a 75-year-old coronary heart disease patient with diabetes and chronic kidney disease, a U.S. doctor might prioritize evaluating the long-term prognosis of TAVR (given the patient's extended life expectancy). In contrast, a Chinese doctor would focus more on “resolving the issue with minimal time and trauma.” This isn't technological conservatism, but a pragmatic trade-off: elderly Chinese patients often have multiple comorbidities and reduced surgical tolerance, making swift, safe treatment more critical than pursuing “cutting-edge technology.”

The “innovation bias” among American physicians stems from their healthcare system's “payment capacity” and “risk tolerance.” Commercial insurance in the U.S. offers extensive coverage (albeit at high costs), enabling doctors to experiment with high-value novel therapies for eligible patients (e.g., gene editing for hereditary arrhythmias, stem cell repair for myocardial damage); Concurrently, stringent adverse event reporting systems (like the FDA's MAUDE system) and robust medical litigation frameworks actually compel physicians to prioritize evidence-based innovation. For instance, TAVR initially faced skepticism due to high paravalvular leak rates, but large-scale real-world studies (such as the PARTNER 3 trial) ultimately established its advantages in specific patient populations.

III. Systemic Transformation: New Possibilities from “Catching Up” to “Collaboration”

Over the past decade, cardiovascular technology exchange between China and the U.S. has shifted from “unidirectional learning” to “mutual empowerment.”

• China exports “clinical expertise” to the U.S.: China's PCI case database—particularly concerning Asian-specific pathologies like anomalous coronary origins and small vessel disease—provides critical data for American medical device companies. For instance, Boston Scientific optimized the delivery system design of its drug-eluting stents based on the vascular diameter distribution of Chinese patients, boosting the product's success rate in Asian markets by 12%.

• The United States shares its “innovation ecosystem”: Through platforms like the “U.S.-China Cardiovascular Innovation Summit,” America's “industry-academia-research-clinical” model (such as the rapid translation chain linking university labs, medical device companies, and clinical centers) is being replicated in China. In 2024, the “biodegradable magnesium alloy stent” jointly developed by Shanghai Jiao Tong University and MicroPort Medical progressed from laboratory to regulatory approval in just four years (compared to the average 6-8 years for similar U.S. products)—a direct outcome of this collaborative approach.

Conclusion: Technology has no endpoint; only answers that bring us closer to life.

Looking back from the vantage point of 2025, the “gap” in cardiovascular surgical technology between China and the U.S. fundamentally reflects differences in developmental stages—China traversed the 70-year journey of U.S. adoption in just 30 years, while the U.S. continues to explore the technological frontiers of the next decade. As the former president of the American Heart Association (AHA) stated during the 2024 U.S.-China summit: “The global challenge of cardiovascular disease requires China's vast clinical experience and America's innovative dynamism to address together. When we discuss the ‘gap,’ we are actually seeking answers that bring us closer to life.”

Perhaps one day in the future, both Ms. Zhang's granddaughter and John's grandson will benefit from a novel interventional device developed through Sino-American collaboration. By then, technology will have transcended labels of “who is more advanced,” focusing instead on a simple aspiration: enabling more people to live longer, healthier lives.

Document dated 2025-10-16 10:28 Modify