On October 30, the lung transplantation team and the cardiac surgery team at the First Affiliated Hospital (FAH) of Xi’an Jiaotong University (XJTU) collaboratively achieved a medical breakthrough by performing a thoracoscopy-assisted minimally invasive aortic valve replacement via intercostal small incision combined with simultaneous right lung transplantation on a 62-year-old patient (Zhang Yi, pseudonym) suffering from pneumoconiosis complicated by cardiac valvular disease. According to a novelty search, this technique constitutes an international first.
Professor Zhang Guangjian (second from left), Director of Thoracic Surgery at the FAH of XJTU, served as the lead surgeon performing the lung transplantation procedure.
In September, the 62-year-old patient, Zhang Yi, had end-stage pneumoconiosis complicated by emphysema, exhibiting progressively worsening symptoms. While the patient sought lung transplantation as a life-saving measure, comprehensive preoperative evaluation revealed coexisting severe aortic valve insufficiency, with cardiac function on the verge of decompensation.
Combined cardiopulmonary disease is a globally recognized therapeutic challenge. Through evidence-based medical analysis and procedural simulations, the teams conclusively determined that performing only aortic valve replacement would leave the patient ventilator-dependent postoperatively due to severe pulmonary impairment from pneumoconiosis. Conversely, performing isolated lung transplantation would carry over 90% mortality risk from perioperative acute heart failure caused by the valvular pathology. The only viable approach was simultaneous surgery, albeit with exceptionally high procedural risks, stated Zhang Guangjian.
Facing this challenge, the FAH of XJTU established a specialized multidisciplinary task force. Co-led by Zhang Guangjian, Director of the Department of Thoracic Surgery, and Yan Yang, Director of the Department of Cardiac Surgery, the team comprised specialists from Anesthesiology, Cardiac Surgery ICU, Ultrasonography, Respiratory Medicine, Transfusion Medicine, and the Organ Procurement Organization (OPO). Through repeated dedicated consultations focusing on surgical strategy, the team ultimately formulated a precise treatment protocol mandating completion of the cardiac procedure within 1.5 hours, followed by lung transplantation concluding within three hours.
On October 2, the procedure progressed with precision according to the established protocol. Following general anesthesia, the cardiac surgery team led by Professors Li Yongxin and Guo Fengwei successfully performed a minimally invasive aortic valve replacement through a thoracoscopy-assisted intercostal small incision under cardiopulmonary bypass support, preserving the stability of the thoracic cage. Intraoperative blood loss was controlled under 50 mL, creating optimal conditions for the subsequent lung transplantation.
Upon completion of the cardiac procedure, the cardiac surgery ECMO (Extracorporeal Membrane Oxygenation) team accomplished the transition from cardiopulmonary bypass to VV-ECMO (Venous-Venous ECMO) within ten minutes, ensuring sustained stability in both respiratory and circulatory functions. Subsequently, the thoracic surgery team led by Director Zhang Guangjian meticulously dissected severely adhesioned pleural tissues under microscopic guidance, achieving precise anastomoses of the right pulmonary arteries, veins, and bronchus. The procedure maintained impeccable hemostasis throughout, with total intraoperative blood loss limited to 150 mL. The patient demonstrated favorable postoperative recovery and has now progressed to independent ambulation.
Yan Yang emphasized that the successful completion of this world's first concurrent minimally invasive aortic valve replacement and right lung transplantation not only breaks through technical barriers to combined cardiopulmonary surgery but also achieves multiple innovations: resolving critical challenges in intraoperative hemodynamic fluctuations, establishing a perioperative management protocol featuring "dynamic anticoagulation dosage adjustment with precise hemostasis", and building a seamless, multidisciplinary surgical workflow. This landmark achievement provides a replicable and scalable treatment paradigm for the treatment of patients with end-stage combined cardiopulmonary diseases.
