Country's first robotic heart transplant a success

Chinese doctors have successfully performed the country's first robotic heart transplant, replacing the failing heart of a 67-year-old man without splitting his breastbone.

The minimally invasive procedure conducted recently at the First Affiliated Hospital of Xi'an Jiaotong University in Xi'an, Shaanxi province, was the third of its kind performed in the world, and offers a safer surgical option for patients in China with end-stage heart failure.

Conventional heart transplant requires a procedure called sternotomy, in which a surgical incision is made through the breastbone, or sternum, to access the thoracic cavity and replace the failing heart with a donor heart.

A median sternotomy — an incision down the middle of the sternum — is the primary approach, as it offers a wide view. However, such a procedure calls for an incision of about 20 centimeters and can cause severe bleeding.

For patients with long-term heart failure or multiorgan injury, such surgery is considered to be highly risky, and recovery and rehabilitation is a lengthy process.

Yan Yang, director of the cardiovascular surgery department at the Xi'an hospital, said that conventional heart transplant also has a short-term postoperative mortality rate of 5 to 10 percent. It is one of the many reasons why robot-assisted minimally invasive surgery is gaining favor globally, he said.

On Oct 5, Yan and his team operated on the 67-year-old with multiple underlying medical conditions, including coronary artery disease, multiple lacunar cerebral strokes and emphysema, a chronic lung condition that causes shortness of breath.

The extensive trauma of sternotomy could easily lead to serious complications such as sternal infection for the patient, Yan said, citing the benefits of a robotic heart transplant.

"Although at an early stage of development, robotic heart transplant may become a routine surgical option in the future to benefit more patients," he said, highlighting that doctors might one day even operate on patients from thousands of kilometers away.

"Perhaps, through our continued efforts, we may truly make it possible for robots to autonomously perform a heart transplant," he added.

Before the robot-assisted surgery on the patient, doctors conducted simulation drills, the hospital said. Using three-dimensional image reconstruction, they tested the incision site, instrument trajectory and donor heart implantation approach on models.

During the surgery, they made only one main working incision of approximately 8 cm between the ribs without sternal division. Two additional tiny trocar holes were created on the chest wall to allow robotic arms to enter the thoracic cavity.

Using a 3D magnified visual field, surgeons controlled the robotic arms to remove the patient's failing heart, implant the donor heart and reconnect blood vessels. Hypothermic preservation of the donor heart was maintained throughout the surgery.

The patient was transferred to the intensive care unit for postoperative monitoring after the donor heart started beating, and was weaned off the ventilator on the same day.

Globally, using robots for conducting heart transplants remains in the exploratory stage. The first such surgery was performed on a 16-year-old patient in Saudi Arabia in 2024, and the second on a middle-aged patient in the United States in 2025.

Yan noted that robotic arms outperform human capabilities in terms of rotation range, stability and dexterity, and they can also execute movements impossible for human hands.

"The core advantage of a robot-assisted transplant is that it preserves the integrity of the thoracic cage, significantly reduces surgical trauma, shortens the recovery period and lowers the risk of infection," he said, adding that it offers a lifeline to patients who previously were not considered a suitable case for heart transplant because of age and underlying medical conditions.

Li Yongxin, deputy director of the Xi'an hospital's cardiovascular surgery department, who also participated in the operation, said the results are better than expected.

"The patient's heart function has fully recovered. ... We will help him build strength step by step with daily physical and cardiac rehabilitation," Li said, adding that the patient is expected to resume normal life in one to two months.