Henan's First Thoracoscopic-Assisted Minimally Invasive Heart Transplant Completed in Zhengzhou

Background

End-stage heart failure occurs when the heart is unable to pump sufficient blood to meet the body's demands. According to reports, a 51-year-old man identified as Mr. Zhang began experiencing symptoms approximately one year prior to surgery, including chest tightness, nausea, vomiting and headaches after activity. These initially improved with rest but later progressed to persistent vomiting, bilateral lower limb edema, shock and syncope. Comprehensive evaluation at The Seventh People's Hospital of Zhengzhou diagnosed end-stage heart failure complicated by coronary heart disease, old myocardial infarction, severe mitral and tricuspid valve regurgitation, atrial flutter and other conditions including coagulation abnormalities and liver dysfunction. Conventional medical and interventional treatments were no longer effective, making heart transplantation the only remaining option.

What was achieved

On March 29, 2026, The Seventh People's Hospital of Zhengzhou completed Henan's first thoracoscopic-assisted minimally invasive heart transplant, reported across multiple Chinese media outlets as the sixth such case publicly documented nationally. The procedure was performed by a multidisciplinary team led by hospital Vice President Zhang Xiangli and Cardiovascular Surgery Ward 8 Director Fu Zhikun, in collaboration with specialists from anesthesiology, ultrasound imaging, critical care medicine and other departments. Preoperative planning lasted approximately one month and incorporated three-dimensional reconstruction technology to simulate the operation.

The surgery lasted about 350 minutes, during which five key vascular anastomoses (left atrium, main pulmonary artery, ascending aorta, superior vena cava and inferior vena cava) were completed under thoracoscopic visualization through a 9-centimeter incision in the right third intercostal space. Aortic cross-clamp time was 99 minutes, with the patient's vital signs remaining stable throughout. Postoperatively, heart rate was maintained at 98 beats per minute and blood pressure at 111/56 mmHg. The patient was transferred to the cardiac surgery intensive care unit, with recovery reported as exceeding expectations. Hospital Vice President Zhang Xiangli was quoted noting that traditional open surgery requires a incision over 20 centimeters with sternal splitting that is excessively traumatic for patients with poor cardiac function. President and Party Secretary Yin Lei stated that the minimally invasive method avoids damaging the sternum and ribs, resulting in smaller trauma, lower infection risk and faster recovery.

How it works

Traditional heart transplantation requires removal of the diseased heart and implantation of a donor heart, involving reconnection of the left atrium, pulmonary artery, aorta and venae cavae. This is typically performed through a large midline sternotomy incision of 20 centimeters or more that splits the breastbone, creating substantial surgical trauma, particularly risky for patients with severely impaired heart function due to higher chances of bleeding, infection and prolonged recovery.

In the thoracoscopic-assisted minimally invasive technique used on March 29, 2026, the patient was placed under general anesthesia in a supine position with the right chest elevated 30 degrees. Surgeons created a 9-centimeter incision in the right third intercostal space without dividing the sternum or ribs. A thoracoscope provided magnified visualization to dissect the pericardium and expose the surgical field. Cardiopulmonary bypass was established peripherally via the left femoral artery and right internal jugular vein, along with inferior vena cava cannulation and left heart venting. Prior three-dimensional reconstruction of the patient's heart and vessels enabled computer-based rehearsal of each step for precision. The donor heart was implanted with double continuous locking sutures at the five anastomoses to ensure hemostasis and prevent stenosis. This approach limits the surgical window while aiming to achieve equivalent functional reconnection with reduced overall trauma.

What it means for international patients

Heart transplantation is governed by strict medical eligibility criteria, organ allocation regulations and requirements for long-term immunosuppression and follow-up. Suitability for a minimally invasive approach depends on individual anatomy, comorbidities and donor matching. International patients must confirm current program availability, eligibility and any support for overseas patients directly with the hospital, as these details are highly case-specific and subject to applicable laws and institutional protocols.

About the hospital

Cardiovascular medicine, cardiovascular surgery and organ transplantation surgery are Henan Provincial key medical disciplines. The hospital maintains high volumes of cardiac interventional procedures and has developed dedicated centers for chest pain, atrial fibrillation, heart failure and cardiac rehabilitation. In addition to its heart transplant program, it has extensive experience in kidney transplantation. Leadership includes Party Secretary and President Yin Lei.