Regional Disparities in Coronary Artery Bypass Surgery in China: A Technical Comparison Between West China Hospital and Fuwai Hospital

In a Shanghai café, Lena Schmidt, an exchange student from the Medical School of Ludwig Maximilian University of Munich, frowned as she leafed through the freshly printed China Cardiovascular Disease Report 2024. Over 4 million coronary bypass surgeries are performed globally each year, with China accounting for one-fifth of that total. But are the disparities between hospitals really that significant?” she murmured, pointing to the chart illustrating “uneven distribution of regional medical resources.” Two days later, armed with this question, she embarked on a research trip to Chengdu's West China Hospital and Beijing's Fuwai Hospital—two institutions hailed by Forbes as “China's twin giants of cardiovascular surgery” that might hold the answers.

I. China's “North-South Axis” of Cardiac Surgery: Why Huaxi and Fuwai?

Within global healthcare systems, the rise of top-tier specialty hospitals is often intertwined with historical legacy, policy support, and clinical demand. China's landscape is no exception:

• Fuwai Hospital (full name: National Center for Cardiovascular Diseases, Fuwai Hospital), located in Beijing, traces its origins to the “People's Liberation Army Chest Hospital” established in 1956. Renamed “Fuwai Hospital” in 1962, it became China's first national-level cardiovascular specialty hospital. It pioneered China's first open-heart surgery with extracorporeal circulation (1958) and first coronary artery bypass grafting (1974). Its cardiac surgery department has ranked first in Fudan University's China Hospital Specialty Rankings for 15 consecutive years, earning international recognition as the “Whampoa Military Academy of Chinese cardiac surgery.”

• West China Hospital (Sichuan University West China School of Clinical Medicine/West China Hospital), located in Chengdu, traces its origins to the 1892 Renji Hospital. It was established as a comprehensive hospital in 1953. Following the implementation of the “Regional Medical Center” policy after 2000, its cardiac surgery department rapidly rose to prominence. In the 2023 Fudan Ranking, West China's cardiac surgery department ranked second nationally (first in Southwest China), performing over 8,000 surgeries annually, with coronary artery bypass grafting accounting for more than 30% of cases.

The double-digit gap in rankings reflects patients' real-world experiences: Data from the first half of 2024 shows that approximately 40% of Fuwai Hospital's CABG patients come from outside the region (primarily North China and Northeast China), while Huaxi Hospital's out-of-region patients account for 55% (covering Southwest, Northwest, and parts of Central China). “When I worked as a village doctor in Yunnan, elderly villagers would say, ‘For heart bypass surgery, go to Chengdu.’ In Shenyang, retired workers discussing bypass surgery would immediately think, ‘Go to Fuwai in Beijing,’” Lena wrote in her research notes.

II. Geographical Coding in Technical Details: Differentiated Advantages of West China and Fuwai Hospitals

The core of coronary artery bypass grafting (CABG) involves “creating a bypass between the aorta and the narrowed coronary artery using the patient's own blood vessels (such as the internal mammary artery or great saphenous vein).” However, in practice, the “technical signatures” of the two hospitals differ markedly, from preoperative assessment to postoperative management.

1. Case Complexity: “Highly Complex Cases” vs. “Standardized Treatment”

Fuwai Hospital prioritizes screening “high-risk, high-difficulty” cases. According to its 2023 annual report, 42% of patients undergoing bypass surgery had comorbidities like diabetes, chronic kidney disease, or malignant tumors, with 38% aged over 70 (compared to a national average of approximately 25%). “We function more like a ‘critical care unit for cardiac surgery,’” explains Wang Jianguo, Chief Physician of Fuwa's Cardiac Surgery Department. "Take a 68-year-old patient with severe renal insufficiency (creatinine 320 μmol/L) and left main coronary artery disease (90% blockage in the heart's most vital vessel). Such surgeries are nearly impossible at primary-level hospitals, but at Fuwa, we have a dedicated ‘multiple organ support team’— —comprising cardiac surgeons, nephrologists, anesthesiologists, and ICU physicians—who discuss the plan two weeks in advance. During surgery, ECMO (extracorporeal membrane oxygenation) provides support, and postoperatively, the patient is transferred to the Cardiac Surgical Intensive Care Unit (CSICU) for 24-hour monitoring."

In contrast, approximately 60% of bypass patients at West China Hospital present with “conventional indications” (e.g., stable angina, single/double vessel disease). Their strength lies in “precise procedures under complex anatomical conditions.” For instance, in patients with severe coronary artery calcification (where vessels harden like “stone”), the Huaxi team has recently promoted “combined rotational atherectomy and laser angioplasty,” boosting success rates from 75% to 92%. For younger patients (<50 years old), they prioritize “total arterial bypass grafting” (using only arterial vessels, such as internal mammary + radial arteries), achieving a long-term patency rate 30% higher than traditional vein grafts. “Southwest China is a high-incidence area for coronary heart disease, but patients tend to be younger (average age 58) and many have a history of living at high altitudes (resulting in unique vascular elasticity). This requires us to pay greater attention to long-term prognosis,” emphasized Professor Li Fang, Director of Huaxi Cardiovascular Surgery.

2. Technological Innovation: “Traditional Refinement” vs. “Frontier Exploration”

Fuwai Hospital's technical hallmark is “standardization and internationalization.” As a National Cardiovascular Center, it has spearheaded multiple international multicenter clinical trials: For instance, the 2022 study comparing Off-Pump Coronary Artery Bypass Grafting (OPCAB) with On-Pump CABG enrolled 5,000 patients across 23 countries, ultimately confirming OPCAB reduces postoperative cognitive impairment risk by 21%. In 2024, Fuwai Hospital pioneered “robot-assisted minimally invasive bypass surgery” in China (achieving vascular anastomosis through a 3-centimeter incision). Though currently limited to select simple cases, this technique has attracted physicians from the Middle East and Southeast Asia for training.

West China Hospital's highlight lies in “localized innovation.” Addressing the demographic of predominantly “farmers/manual laborers” in Southwest China (requiring rapid return to work post-surgery), they optimized the Enhanced Recovery After Surgery (ERAS) protocol: for instance, permitting clear broth consumption two hours pre-surgery (versus traditional eight-hour fasting) and reducing the time to first ambulation from 24 to 6 hours post-surgery. In collaboration with the Huaxi Rehabilitation Medicine Center, they developed “Cardiac Postoperative Breathing Exercises” (incorporating Sichuan Opera breathing techniques), reducing atelectasis incidence by 18%. More notably, Huaxi is pioneering a “primary-care hospital-regional center” referral model: via 5G telemedicine systems, primary-care physicians can transmit patient CT and angiography data in real time, enabling Huaxi specialists to pre-plan surgeries. This reduces patient surgery time by 30% upon arrival at Huaxi. “Our goal is for 90% of simple bypass surgeries to be performed at primary care facilities, with West China Hospital only accepting the most complex cases,” stated Professor Li Fang.

3. Patient Experience: “International Standards” vs. “Human Touch”

For international patients, the two hospitals exhibit significant differences in “service details.” As a “directly affiliated institution of the National Health Commission,” Fuwai Hospital's International Medical Department offers fully English-language services, with translation teams available from admission registration through post-operative follow-ups. Its post-operative recovery area features internationally certified nutritionists (offering customizable halal and vegetarian meals) and direct billing with multiple international insurers (e.g., Blue Cross of America, Bupa UK), eliminating upfront costs for patients. However, some international patients noted “excessively strict procedures”—such as visitation hours limited to 3:00 PM–4:00 PM daily with a maximum of two visitors per session, implemented to minimize infection risks.

West China Hospital's “humanistic care” carries distinct Chinese characteristics. In cardiac surgery wards, the “Gratitude Board” at the nurses' station displays handwritten thank-you notes from patients' families (in Sichuan dialect: “The doctors and nurses literally pulled this old man back from the brink of death!”). For elderly patients, nurses teach family members the “back-patting phlegm-clearing technique” (synchronized to the rhythm of Sichuan folk songs). During postoperative recovery, the hospital cafeteria offers “Sichuan-style nutritious meals” (like low-salt twice-cooked pork and light chicken soup noodles). Nurses even explain medication precautions in local dialect (“Take this medicine before meals, just like pairing sweet rice wine with eggs”). “This place doesn't feel like a hospital—it feels more like home,” remarked a patient from Myanmar upon discharge.

III. The “Chinese Healthcare Ecosystem” Behind Regional Disparities

Lina's research reveals that the differences between West China Hospital and Fuwai Hospital essentially reflect the regional division of healthcare labor: Beijing, as a hub of medical resources, concentrates national-level capabilities for treating complex and critical illnesses; Chengdu, as the central city of Southwest China, shoulders the responsibility for standardized treatment of prevalent diseases within the region and facilitates the dissemination of medical technologies. This disparity does not signify a hierarchy of quality but rather reflects the inevitable outcome of China's tiered healthcare system.

As Academician Hu Shengshou, President of Fuwai Hospital of the Chinese Academy of Medical Sciences, stated: “The development of cardiac surgery in China must both ‘climb Mount Everest’ (conquer global challenges) and ‘cover the grasslands’ (benefit grassroots patients).” Professor Li Weimin, President of West China Hospital, added: “Geographical differences are not divides but complements—Fu Wai's expertise spreads nationwide through academic conferences and visiting physicians, while West China's experience trickles down to county hospitals via regional medical consortiums. Ultimately, every patient benefits.”

Conclusion: When Two Titans Meet, China's Healthcare Future Comes into Focus

Before leaving Chengdu, Lena encountered an elderly patient awaiting surgery in the Huaxi Hospital corridor. Clutching her hand, the man asked, “Young lady, which is better—Fuwai or Huaxi?” After a moment's thought, she replied, "If you have a complex case, Fuwai is like a ‘special forces unit’; if you need long-term rehabilitation, Huaxi is like a 'community caretaker.' But whichever you choose, you'll receive the best care—because China's cardiac surgery has already taken center stage on the global stage."

Perhaps this is the most moving testament to China's healthcare: possessing both the “hardcore strength” of top-tier hospitals and the “warm wisdom” of regional collaboration. This harmonious coexistence of diversity will ultimately restore “hope for the heart” to countless patients.

Document dated 2025-10-16 10:25 Modify