China Completes World's Third Robotic Arm-Assisted Heart Transplant

Background

End-stage heart failure occurs when the heart cannot pump blood effectively, often requiring transplantation as the definitive treatment for suitable candidates. Traditional heart transplantation involves a large incision and sternotomy, splitting the breastbone, which can result in substantial trauma, increased infection risk, prolonged mechanical ventilation, and slower recovery, particularly for older patients with multiple underlying conditions. Reports indicate conventional heart transplantation carries a short-term postoperative mortality rate of 5 to 10 percent.

Robotic-assisted techniques aim to reduce these risks by enabling surgery through smaller incisions. The application to full heart transplantation is novel and remains in early stages worldwide. The first such robotic arm-assisted heart transplant was completed in Saudi Arabia in 2024 for a 16-year-old patient. The second was performed in the United States in 2025. China became the third country to achieve this with a case on October 5, 2026.

What was achieved

The First Affiliated Hospital of Xi'an Jiaotong University performed China's first robotic arm-assisted heart transplant on October 5, 2026, marking the world's third such surgery. The patient was a 67-year-old man with end-stage heart failure who had experienced progressive symptoms for years, including chest tightness and shortness of breath on exertion. In the recent period before surgery, his condition deteriorated with orthopnea, severe bilateral leg edema, and significant weight gain. Diagnostic tests revealed a left ventricular ejection fraction of 19 percent, with severe regurgitation of multiple valves, coronary artery disease, multiple lacunar cerebral infarctions, and emphysema.

Led by cardiovascular surgery director Yan Yang and deputy director Li Yongxin, who operated the robotic arms, the team successfully implanted a donor heart matched through the national organ allocation system. The surgery was completed without sternotomy. Postoperatively, the patient was weaned from the ventilator on the same day, transferred to the cardiovascular intensive care unit, and exhibited positive early recovery with the transplanted heart functioning well. Yan Yang highlighted the potential for this method to benefit high-risk patients by preserving chest wall integrity and reducing complications.

How it works

In conventional heart transplantation, surgeons open the chest widely by dividing the sternum to access and remove the failing heart before implanting and suturing the donor organ to the great vessels and atria. The donor heart is preserved in a cold state during transport and implantation to minimize damage. In the robotic arm-assisted minimally invasive version performed here, surgeons avoid the large traditional chest opening. Instead, they create one primary 8 cm incision between the ribs as the main working port for extracting the failing heart and inserting the new one, along with two small additional trocar ports on the right chest wall for the robotic arms.

Operating from a control console, the team viewed a magnified three-dimensional high-definition image of the interior. The robotic arms, offering enhanced dexterity, stability, and range of motion, were used to dissect the native heart, position the cold-preserved donor heart, and perform precise suturing of five critical anastomoses: the left atrium, pulmonary artery, aorta, superior vena cava, and inferior vena cava. The donor heart was protected with cold solution during anastomosis. Upon completion, the heart was reperfused, de-aired, and began beating independently. The absence of bleeding was confirmed, and the small incisions closed, avoiding any bone division for reduced trauma.

What it means for international patients

This achievement demonstrates advancing expertise in minimally invasive cardiac transplantation techniques at Chinese medical centers, which could offer reduced recovery times and lower certain risks for appropriately selected high-risk patients. The First Affiliated Hospital of Xi'an Jiaotong University operates an International Treatment Department, also known as the VIP Clinic or foreign-related ward, established in July 2017. This service provides high-end medical care, including for international patients, with dedicated beds, hotel-style accommodations, multidisciplinary expert teams, and coordinated pathways for consultation, treatment, and follow-up.

International patients interested in heart transplantation or related cardiac care must confirm eligibility, suitability for robotic-assisted approaches, organ allocation processes, and all other details directly with the hospital. Such procedures require comprehensive multidisciplinary evaluation, compliance with national regulations on organ donation and transplantation, and individual medical assessment. The hospital's English website and international patient services can serve as initial points of contact.

About the hospital

The First Affiliated Hospital of Xi'an Jiaotong University is a large comprehensive tertiary Grade III Level A hospital located in Xi'an, Shaanxi province. Affiliated with Xi'an Jiaotong University and under the administration of the National Health Commission, it traces its origins to 1937 with formal establishment in 1956. It features approximately 4,590 beds and more than 7,700 staff, including numerous senior specialists. The hospital integrates medical care, teaching, research, and prevention services.

It holds qualifications for all major organ transplants, including heart, liver, kidney, lung, pancreas, and small intestine, with reported volumes exceeding 8,100 kidney transplants and 1,800 liver transplants. Cardiovascular diseases and organ transplantation are key strengths, supported by 27 national clinical key specialty construction projects. The facility has an active International Treatment Department serving foreign patients and participates in international medical training and exchanges. It has performed consistently well in national performance assessments of tertiary public hospitals.