Temporal and Regional Differences in Congenital Heart Surgery in China (2017-2022): Trends and Implications

Background: With the decline of birth population and the development of medical technology in China, studies assessing how these changes have affected the adoption of congenital heart disease surgery at the national or regional scale are lacking. Methods: We investigated the status of congenital heart surgery in China in the period from 2017-2022, through investigation of the total rates of cardiac surgeries, cardiopulmonary bypass (CPB), adult congenital heart surgeries (CHS), and pediatric CHS (<18 years old), as recorded by the Extracorporeal Circulation Branch of the Chinese Society of Biomedical Engineering. Subsequently, we evaluated correlations between these factors with economic, demographic, and other factors. Results: From 2017 to 2022, the total number of cardiac operations increased from 230,772 to 263,292, representing an increase of 14.09% over 6 years; the CHS dropped from 76,365 to 68,940 (10.19% decrease), and the proportion of CHS in the total cardiac surgeries dropped from 33.26% to 26.18% (7.08% decrease). Finally, cases of pediatric CHS decreased from 61,825 to 38,174 (38.25% decrease). The annual percentage change (APC) of the total amount of pediatric CHS cases was - 10.03 (-15.95 to - 3.69, p = 0.013). Adult CHS increased from 14,940 to 30,766 (105.93% increase). The proportion of adult CHS cases of the total number of cardiac surgeries increased from 6.47% to 11.68% (5.21% increase). From a regional perspective, the APC for the proportion of pediatric CHS in the local population was generally lower in western China. The proportion of CHS in the local population generally decreases from the north to the south, although the lowest incidence is found in the northeast region. Conclusions: Due to demographic changes, medical technology and economic factors, the number of surgical operations for congenital heart disease (CHD) in children decreased significantly from 2017 to 2022, and may decline further in the future. Nevertheless, in the same period, a significant increase in the number of operations for CHD in adults was observed, which brings new opportunities and challenges to the development of congenital cardiac surgery and cardiac critical care.