China's First Robotic Heart Transplant Successfully Performed in Xi'an

Background

Heart transplantation remains a critical treatment option for patients with end-stage heart failure when other medical therapies are no longer effective. Traditional procedures involve a major midline incision and division of the sternum to access the heart, resulting in significant surgical trauma, prolonged recovery times, higher risks of infection and complications, especially among older patients or those with multiple underlying conditions such as lung disease or vascular issues.

Globally, the application of robotic technology to heart transplantation is in its early exploratory phase. The world's first such procedure was completed in September 2024 at King Faisal Specialist Hospital in Saudi Arabia. This was followed by the first in North America in March 2025, performed by a team at Baylor College of Medicine in Houston led by Professor Kenneth K. Liao. These milestones set the stage for further development of minimally invasive approaches in the field.

What was achieved

On October 5, 2026, a surgical team at The First Affiliated Hospital of Xi'an Jiaotong University successfully performed China's first robotic-assisted minimally invasive heart transplant. This also marked the world's third such procedure. The patient was a 67-year-old man diagnosed with end-stage heart failure. Cardiac ultrasound showed a left ventricular ejection fraction of only 19 percent, along with severe regurgitation of the mitral, tricuspid and aortic valves. He also had coronary artery disease, multiple lacunar cerebral infarctions and emphysema, making him a high-risk candidate for conventional open-chest surgery.

The operation was led by Yan Yang, director of the hospital's cardiovascular surgery department, together with Li Yongxin, deputy director, and involved other team members including Li Jing. The patient was weaned from mechanical ventilation on the day of surgery and transferred to the cardiovascular surgical ICU for monitoring. According to Li Yongxin, the patient's heart function has fully recovered. With step-by-step physical and cardiac rehabilitation, he is expected to resume a normal life in one to two months. Yan Yang highlighted that avoiding sternal division reduces risks such as sternal infection in vulnerable patients.

How it works

In a standard heart transplant, surgeons create a large incision through the center of the chest and divide the breastbone with a saw to gain direct access to the heart. This sternotomy creates considerable trauma to the chest wall and can complicate recovery, particularly for patients with preexisting lung conditions. The robotic-assisted technique uses much smaller access points and advanced technology to complete the replacement while preserving the structural integrity of the chest.

The procedure involved a single main incision of approximately 8 centimeters made between the ribs to create a working window through which the diseased heart could be removed and the donor heart implanted. Two additional small trocar ports were created on the right chest wall to accommodate the robotic instrument arms. From a control console, the surgeons utilized the system's three-dimensional, high-definition magnified visualization to precisely dissect and remove the failing heart. The prepared donor heart was then introduced, maintained under cold protection. Using the robotic arms' dexterity in the confined space, the team completed five precise vascular anastomoses connecting the left atrium, pulmonary artery, aorta, superior vena cava and inferior vena cava. Once suturing was finished, the team performed de-airing, rewarming and aortic unclamping, allowing the donor heart to resume beating spontaneously without bleeding complications. The small incisions were then closed.

What it means for international patients

This procedure demonstrates progress in reducing the invasiveness of heart transplantation, which may offer an alternative for certain high-risk international patients with end-stage heart failure who might not tolerate traditional sternotomy well. The hospital operates an International Treatment Department, established in 2017, that provides services for overseas patients, including those from countries participating in the Belt and Road Initiative. It also conducts international training programs in minimally invasive cardiac surgery that have attracted participants from nations including Japan, South Korea, Indonesia and Brunei.

Availability and eligibility for heart transplantation, including robotic-assisted approaches, are subject to strict medical evaluation, organ allocation regulations, compatibility requirements and legal frameworks governing transplantation for non-residents. International patients should contact the hospital directly to confirm current capabilities, individual suitability and all necessary documentation and processes.

About the hospital

The First Affiliated Hospital of Xi'an Jiaotong University is a comprehensive Grade III Level A tertiary teaching hospital located in Xi'an, Shaanxi province. Affiliated with Xi'an Jiaotong University and founded in 1956, it is one of the major medical centers in northwest China. The facility holds qualifications to perform all major organ transplants, including heart, liver, kidney, lung, pancreas and intestine, and has conducted multi-organ combined transplants.

Its cardiovascular surgery department, one of the earliest established in China, specializes in minimally invasive and complex cardiac procedures. The hospital's heart transplantation program began in 2022 and achieved national top-ten cumulative volume status, with 48 cases in 2023 ranking fifth nationally at that time. By late 2025, the cumulative total exceeded 100 cases. The department emphasizes minimally invasive techniques, with high volumes of procedures such as valve surgeries, aortic operations and left ventricular assist device implantations. It maintains an English-language website and international training initiatives, supporting its role in serving patients beyond the local region.