Chinese Structural Week 2021 Ge Junbo: A Brief History of Transcatheter Treatment of Structural Heart Disease in China

Structural heart disease (SHD) of intervention in recent years, cardiac vascular interventional diagnosis and treatment of the most rapid development of the field
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With the continuous development and promotion of new SHD treatment technologies around the world, the concept of SHD has gradually become familiar to the academic community and the public

Heart Vascular Clinic Junbo Ge

SHD definition, category

SHD definition, category

At the CSI conference in 2005, Professor Horst Silvert from Germany formally proposed the concept of SHD for the first time, defining it as any abnormality of the heart structure, any disease related to the structure of the heart and large blood vessels; with the gradual deepening of the understanding of SHD, academician Ge Junbo in 2021 The published literature defines SHD as any disease related to the heart and the large blood vessel structure of the heart other than the electrocardiographic disease and coronary artery disease.
Its characteristic is that the disease can be treated by correcting or changing the heart and large blood vessel structure
.

According to its definition, structural heart disease can be divided into congenital heart disease (ventricular septal defect, atrial septal defect, etc.

thrombus

SHD treatment mainly includes drug treatment, surgical treatment and interventional surgery
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Among them, interventional therapy has become one of the most important treatments for SHD, including transcatheter occlusion of congenital heart disease, traditional transcatheter valve therapy (PBMV, PBPV, PBAV), and emerging transcatheter valve therapy (TAVR).

The 20th century exploration process in the field of structural heart disease in China

The 20th century exploration process in the field of structural heart disease in China

At present, the field of structural heart disease in China is in a stage of rapid development.
The academic community's understanding of structural heart disease is changing with each passing day.
A variety of new devices and technologies for interventional treatment of structural heart disease are flourishing and flourishing.
This result has appeared.
It stems from years of continuous exploration and experimentation
.

In 1981, Professor Zhou Aiqing of Shanghai Children's Medical Center and others reported for the first time a case of atrial septostomy using percutaneous balloon.
This is the latest report of interventional treatment of structural heart disease in China
.

Professor Chen Chuanrong of Guangdong Heart Research Institute pioneered percutaneous balloon mitral valvuloplasty (PBMV) and percutaneous balloon pulmonary valvuloplasty (PBPV) in 1985

child

The development of the new century-first heart intervention

The development of the new century-first heart intervention

However, the domestic structural heart disease field has truly entered the stage of rapid development in the 21st century, and huge breakthroughs have been made in the fields of congenital heart intervention, valve intervention, and left atrial appendage occlusion
.

In 2001, Professor Zhu Xianyang from the General Hospital of the Northern Theater District took the lead in China to apply the Amplatzer muscle occluder to treat muscle VSD successfully; in 2002, the Amplatzer membrane VSD asymmetric occluder also entered the country, but postoperative complete atrioventricular block (CAVB) has a high incidence and has not been widely promoted
.

Since 2001, Professor Qin Yongwen has developed three types of VSD occluders based on Amplatzer VSD, which have been approved for marketing and have been widely used in clinical practice

Development in the new century-valve intervention

Development in the new century-valve intervention

The domestic congenital interventional field has officially set foot in the international leading level, and the development of the domestic valve intervention field should also not be underestimated
.

On October 3, 2010, academician Ge Junbo from Zhongshan Hospital of Fudan University and others completed the first domestic TAVR operation (CoreValve, the second in Asia), officially opening a new chapter in domestic transcatheter aortic valve intervention

In 2017, China's original new generation of Qiming Medical aortic valve was approved by the State Food and Drug Administration for registration and marketing, opening the A era of transcatheter valve replacement in China
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With the development and listing of domestic aortic valve interventional devices, the promotion and standardization of domestic valve intervention concepts and technologies is also inevitable: In 2018, China's first TAVR clinical pathway (written by Professor Wu Yongjian, etc.

In addition, during the OCC meeting in May 2012, Zhongshan Hospital Affiliated to Fudan University completed the first three MitraClip operations in China, a precedent for mitral regurgitation intervention
.

Subsequently, the team of Academician Ge Junbo of Zhongshan Hospital affiliated to Fudan University used a self-developed minimally invasive interventional device in 2018 to successfully complete the world's first transapical mitral valve clamping operation

China has also made outstanding achievements in the field of pulmonary valve and tricuspid valve intervention
.
In 2013, Zhongshan Hospital Affiliated to Fudan University took the lead in using the domestic VenusP-Valve transcatheter self-expanding pulmonary valve to complete the first domestic PPVI.
Since then, Venus-P has been promoted and applied in 338 cases in 22 countries around the world, which is congenital Patients with severe pulmonary regurgitation after RVOT enlarged reconstruction in cardiology surgery bring more options
.
In 2018, LuX-Valve, the first transcatheter tricuspid valve replacement system independently developed in China, completed pre-market clinical trials and is expected to become the world's first approved TTVR valve
.
In 2021, the team of Zhongshan Hospital affiliated to Fudan University took the lead in using K-Clip to complete the first transvascular tricuspid valve repair operation in China
.

Development in the new century-left atrial appendage occlusion

Development in the new century-left atrial appendage occlusion

In recent years, the heart valve device industry in China has developed vigorously, and under the strong support and policy guidance of the country, a number of excellent interventional heart valve research and development high-tech enterprises and several independently developed new interventional valves with independent intellectual property rights have emerged.

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This is also true in the field of left atrial appendage occlusion in China, and good results have been achieved in equipment, surgical procedures, and technical promotion
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In terms of equipment selection, there are far more choices of left atrial appendage occlusion equipment in China than in Europe and the United States
.
Over the years, China has consistently introduced excellent left atrial appendage occlusion devices from abroad and continued to develop domestically produced devices.
At present, Poco, Lifetech, and Pushi have a relatively high proportion in the left atrial appendage occlusion device market in China, and more will emerge in the future.
Or original or imitation left atrial appendage occluder, providing patients with more choices
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In terms of technology promotion and surgical improvement, a total of about 28,000 left atrial appendage occluders have been implanted in China, which has maintained a rapid growth rate since 2018, and more independent surgeons have continued to emerge; left atrial appendage occlusion surgery After many improvements, the current minimalist LAA occlusion can be done with local anesthesia without DSA guidance or pure ultrasound guidance
.
With the continuous improvement and optimization of equipment in the future, the complexity and risk of surgical operations will also improve, in order to provide patients with better medical services and better prognosis
.

Development in the new century-other technologies

Development in the new century-other technologies

Driven by huge market demand, congenital intervention, valve intervention and left atrial appendage occlusion are undoubtedly the hottest and fastest-growing research fields in SHD intervention, but other than that, the country has never given up other SHDs.
R&D and exploration of interventional technology
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In 2013, Professor Huo Yong was the first in China to perform percutaneous ventricular reconstruction on two patients with old anterior myocardial infarction combined with ventricular aneurysm through minimally invasive interventional methods , achieving a zero breakthrough in this technology in China; affiliated to Xiamen University The Cardiovascular Hospital has made good progress in the direction of left ventricular aneurysm folding, and has completed more than 20 cases; in 2016, Professor Liu Liwen from Xijing Hospital of the Air Force Military Medical University invented the Liwen technique, opening a new era of HOMC treatment; Nanjing, 2018 Professor Kong Xiangqing's team from the First Clinical Medical University of Medical University completed the adjustable radiofrequency atrial shunt operation and explored the treatment of heart failure .
The technology has now entered the pre-market clinical trial stage; in 2020, the team of Professor Dong Nianguo, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology Developed the D-shunt atrial septal shunt, which was also used to explore the treatment of heart failure and entered the formal clinical trial stage
.

Myocardial infarction heart failure

Summary and outlook

Summary and outlook

Interventional treatment of structural heart disease is the fastest growing field in cardiovascular interventional diagnosis and treatment in recent years, and the field of structural heart disease in China will continue to show a vigorous development in the next few years
.
As far as the field of congenital intervention is concerned, China has a long history of development, and has now been able to widely develop this technology on the shoulders of giants, and is the world leader in ventricular occlusion and new congenital occluders; and China The field of valve intervention started late, but under the leadership of several centers, it is entering the era of rapid development of valve intervention; at the same time, China’s new left atrial appendage occlusion device has also been successfully developed and applied in clinical practice, making the left atrial appendage occluded The operation is safer, more effective and convenient; the domestic self-made SHD interventional technology (left ventricular reconstruction, folding technology, Liwen operation, etc.
) is also being explored and verified
.
All in all, although SHD intervention in China started late, it has developed rapidly, and has formed unique characteristics and innovations.
At the same time, as a new hot spot in interventional cardiology with great prospects, the opening of new technologies for the treatment of structural heart disease has led China's interventional heart The fourth revolution in disease
.

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