Transcatheter aortic valve replacement (TAVR) is effective in the treatment of severe symptomatic aortic stenosis and its applicable population is also gradually expanding, but it carries risk of ischemic and bleeding events, which underscores the importance of optimizing adjuvant antithrombotic regimens. The release of the 2022 version of Chinese expert consensus on antithrombotic therapy after transcatheter aortic valve implantation has promoted the standardized and safe development of antithrombotic therapy after TAVR in China. Combined with the latest progress of antithrombotic therapy after TAVR, from emphasizing ischemia and bleeding risk assessment, single-agent antiplatelet therapy for patients without anticoagulation indications, the selection of antithrombotic strategies for patients with other antithrombotic indications, antithrombotic strategy changes in postoperative valve thrombosis and bleeding events, this article interprets this consensus.
Metabolic and bariatric surgery has continued to evolve under the dual imperatives of efficacy and safety. Sleeve gastrectomy (SG) with transit bipartition (SG-TB), derived from SG, reconstructs a “dual-channel” pathway that preserves the pylorus and proximal small-bowel function, while aiming to achieve metabolic effects comparable to biliopancreatic diversion with fewer severe nutritional complications. In 2025, the first Chinese expert consensus on SG-TB was released, and the inaugural international SG-TB consensus meeting was convened in Europe, reaching preliminary alignment on procedure classification, key technical parameters, and indications/contraindications. Emerging clinical evidence indicates that SG-TB confers advantages in weight reduction, remission of type 2 diabetes, and prevention of gastroesophageal reflux disease, and also demonstrates feasibility in revisional surgeries and complex cases. Nevertheless, current studies are predominantly observational, with limited evidence quality and considerable heterogeneity. Stratification of surgical parameters and establishment of reproducible training systems remain unmet needs. Building upon a synthesis of national and international consensus statements and recent clinical advances, this commentary further analyzes the challenges that SG-TB faces in procedural heterogeneity, evidence accumulation, individualized practice, and mechanistic research. This commentary seeks to offer practical reference and research directions for the bariatric community, ultimately supporting the advancement of SG-TB from a promising technique toward standardized and mainstream adoption.
The incidence of chronic venous disease (CVD) is significantly higher in the elderly population compared to non-elderly individuals, with more severe disease manifestations. Additionally, elderly CVD patients often have comorbid conditions such as cardiovascular diseases, making the evaluation process more complex and increasing treatment difficulty. Currently, there are no established recommendations in China for the diagnosis and treatment of CVD in individuals aged 60 and above. Against this backdrop, the Peripheral Vascular Disease Management Branch of the Chinese Geriatric Society has developed the Chinese Expert Consensus on the Diagnosis and Treatment of Chronic Venous Disease in the Elderly based on domestic and international guidelines, relevant evidence-based medical research, and the physiological and clinical characteristics of the elderly population in China. This consensus aims to provide an important reference for improving the diagnosis and treatment of CVD in elderly patients in China.
In patients with a functionally univentricular heart, the Fontan strategy achieves separation of the systemic and pulmonary circulation and reduction of ventricular volume overload. Contemporary modifications of surgical techniques have significantly improved survival rate. However, the resulting Fontan physiology is associated with high morbidity. Despite large improvements in outcomes of contemporary Fontan patients, a large burden of disease exists in this patient population. In face of the imbalance of medical resources in China and different understanding of Fontan treatment in various regions, there is no consensus on the current status of Fontan strategy, surgical technique and perioperative treatment. By reviewing large amounts of literature, assessing survival rate and risk factors for mortality and complications of the Fontan circulation, knowledge sharing from tens of experts, we achieved a consensus on many aspects of palliation of Fontan. We hope this consensus will help Chinese colleagues further continue their efforts to improve surgical outcomes of the univentricular heart patients.
The application of inpatient electronic medical records (EMRs) is a crucial component of modern healthcare informatization, and also a key factor in improving medical quality and safety. Establishing standardized EMRs for thoracic surgery helps to standardize treatment processes, improve medical efficiency, enhance quality of care, and better ensure patient safety. It also facilitates the collection and use of standardized and structured data, promoting clinical decision-making, the application of artificial intelligence, and the development of specialized clinical centers. Considering relevant national policies, information standards, clinical practice challenges and latest research findings in thoracic surgery EMRs, Chinese Association of Thoracic Surgeons, Cross-Strait Medicine Exchange Association’s Thoracic Surgery Professional Committee, WU Jieping Medical Foundation’s Lung Cancer Professional Committee, Zhejiang Provincial Thoracic Surgeons Associations and Fujian Provincial Thoracic Surgeons Associations have explored innovative paths for EMRs development. Through multiple rounds of professional discussions and research, the "Chinese expert consensus on quality control and management of electronic medical records for thoracic surgery (2024 version)" was formulated. It aims to provide a reference for the construction and application of inpatient EMRs for thoracic surgeons and information professionals across China, promoting continuous improvement in the informatization and medical standards of the thoracic surgery field, and contributing to the construction of "healthy China".
Neurofibromatosis type 1 (NF1) is an autosomal dominant neoplastic disease caused by mutations in the NF1 gene and one of the most challenging diseases to treat. Patients have a characteristic phenotype with neurofibromas as the main features in different forms, including numerous cutaneous neurofibromas, plexiform neurofibromas involving the primary nerves, or malignant peripheral nerve sheath tumors with a very short survival period after malignant transformation. NF1 patients also suffer from multi-system involvement, with a high rate of deformity and disability, making complete surgical resection more difficult. Currently, there is no consensus on the diagnosis and treatment of NF1 in China, and different disciplines have different understandings of NF1. Multidisciplinary systematic evaluations and cooperative treatments are the keys to improve the treatment, quality of life, and prognosis of NF1 patients. In 2020, the Department of Plastic Surgery of the Ninth People’s Hospital of Shanghai Jiaotong University School of Medicine led the establishment of the first multi-center collaboration group for NF1 in China. Furthermore, the group had worked with renowned experts from the various departments including surgical oncology, medical oncology, dermatology, reproductive medicine, et al. in China to formulate the “Expert consensus on diagnosis and management of neurofibromatosis type 1 (2021 edition)”, aiming to promote standardized and homogeneous treatment covering the whole life cycle of NF1 patients and improve the treatment level and outcome of NF1 patients in China.
Double outlet right ventricle (DORV) is a complex cardiac malformation with many anatomic variations and various approaches for surgical repair. DORV is mainly defined as the congenital heart disease with ventriculoarterial connection in which both pulmonary artery and aorta arising primarily (>50%) from the right ventricle, associated with continuity or discontinuity between the aorta and mitral valve. DORV can be subclassified by various ways. Now subclassification is usually performed according to the relationship between the ventricular septal defect (VSD) and the great arteries. Various approaches for surgical repair of DORV ranging from single ventricle palliation to biventricular repair are reported from many centers. However, the high-grade guideline of surgical management of DORV is still absent. Hence, we developed the Chinese expert consensus on DORV as the evidence for surgical strategies.
We update the "2021 expert consensus on clinical pathway for transcatheter aortic valve replacement in China" using the Delphi method. By searching for evidence related to the clinical pathways of transcatheter aortic valve replacement (TAVR) in PubMed, CIKI, and Wanfang Database over the past four years, 35 core viewpoints were proposed in four directions: TAVR team composition and clinical evaluation, perioperative imaging assessment, surgical process, and perioperative and postoperative long-term management of patients. The specific updates include: refining the responsibilities and composition of the TAVR team, clarifying the steps and content of clinical evaluation; emphasizing the core position of CT in perioperative imaging assessment, and introducing the application of new technologies such as artificial intelligence, numerical simulation, and 3D printing; optimizing the TAVR surgical process, including anesthesia selection, access establishment, valve selection and release, and others; and proposing management strategies for special types of patients (such as emergency TAVR, simplified TAVR, pure aortic regurgitation, combined coronary heart disease and atrial fibrillation). In addition, the consensus also emphasizes the importance of postoperative follow-up and rehabilitation, and provides detailed antithrombotic and rehabilitation guidance. The update of this consensus will further promote the standardized development of TAVR technology in China and improve clinical treatment effects.
Myasthenia gravis (MG) is an autoimmune disease with indefinite pathogenesis. MG is closely related to thymic diseases, and thymectomy is an important way for MG treatment. However, there are some controversies regarding thymectomy, including indications, operation opportunities, operative procedures, surgical approaches, perioperative managements, and efficacy evaluations, etc. Therefore, based on the literature and the experience of Chinese experts, this consensus has been written after careful discussion and inquiry and 29 recommendations have been made, aiming to guide surgical treatment of MG and improve the clinical outcomes.
Cardiac surgery is often associated with significant trauma, which can lead to a suboptimal recovery experience for patients. With advancements in cardiovascular surgical techniques, the rates of surgical mortality and complications have significantly decreased, leading to increased attention on patients' subjective recovery experiences after the surgery. Patient-reported outcomes (PROs) refer to the feedback provided directly by patients regarding their health status, functional abilities, and treatment experiences. Accurate assessment and timely intervention of PROs have become a growing area of interest in the academic community, with improvements in certain PROs showing significant correlations with prognostic benefits. However, there remains controversy regarding which dimensions of PROs should be prioritized in the postoperative recovery of cardiac surgery patients and how to select appropriate evaluation scales for these dimensions. We referenced the research progress both domestically and internationally, combined with clinical practices from around the world, and widely solicited expert opinions to reach a consensus on the evaluation dimensions of postoperative PROs for cardiac surgery patients. This includes the overall recovery status of patients (surgical recovery, quality of life) and its nine dimensions (pain, physiology, sleep, thirst, frailty, activity, cognition, mental health, and social support). This consensus comprehensively considers the application of PROs scales, and introduces 1-3 scales with the widest application and most solid evidence for each dimension, aiming to further standardize the evaluation dimensions of PROs after cardiac surgery in China and the selection of scales for each dimension.
