Life-saving speed: Green Channel for Life made possible by the DeltaHealth Model

Six years into his career at DeltaHealth, Prof.Sun Lizhong, the medical president of the hospital said proudly: “In DeltaHealth, the average door to OR time for emergency patients under 1.5 hours.”(* Internal data of DeltaHealth) In 2016, in pursuit of better patient experience, Prof.Sun Lizhong, the creator of “Sun’s Procedure”, joined DeltaHealth Hospital in Shanghai to explore the potential of non-public medical institutions.

As a non-public medical institution, DeltaHealth Hospital’s short history never gets in the way of achieving greatness in diagnosis and treatment of great vessel diseases. The hospital is particularly outstanding in emergency treatment of acute Type-A aortic dissection, thoracoabdominal aortic surgery and complex and challenging aortic surgeries.

The original DeltaHealth model of emergency surgery adopts cutting edge management model from oversea to accommodate the reality in China, creating a Green Channel for Life that optimizes efforts to save patient’s life, including case discussion, preoperative preparation, emergency OR scheduling and staffing.

Defying death: Prof.Sun Lizhong and Sun’s procedure

In 2003, as a cardiovascular surgeon of Fuwai Hospital in Beijing, Dr. Sun Lizhong spent all day contemplating surgical technique. The quarantine after tending SARS patient gave him just the time he needed.

Dr. Sun Lizhong realized that the artificial graft for aortic dissection surgery prone to distortion and bending, posing great challenge to implantation and compromising surgical outcome. Inspired by intervention technology, he developed a stent graft and delivery system and invented the surgery of  aortic arch replacement and stent elephant trunk, simplifying the operation and improving the outcome. The Sun’s procedure was born.

Also in 2003, a 20-year-old young man with extensive aortic aneurysm was admitted into ward room No.10 of Fuwai Hospital, after being turned away by multiple major medical centers in China. As his attending doctor in Fuwai Hospital, Dr. Sun Lizhong applied “tubular angioplasty of artery”, a unique surgical technique intercostal artery anastomosis, and “staged circulation arrest for major arterial reconstruction” in the surgery.

The 12-hour surgery saved the young man’s life, marking another milestone in the history of Aortic Surgery in China –one-stop total aortic.

Exploration and achievements: Sun’s Procedure, the core of the China Model of aortic diagnosis and treatment

Aorta is the biggest artery in the body, any lesion of this artery is particularly threatening. Annual incremental aortic cases in China are estimated at 10k to 50k, 70% of which are aortic dissection [1], 62~91% patients with Type-A dissection die within 1 week upon onset [2]. Surgery is the only way to safe their lives.

However, aortic surgery involves multiple major organs and registers high complication rate and mortality rate, making it particularly challenging.

Sun’s Procedure: the surgery targeting Type-A aortic dissection improves protection of major organs and blood in aortic surgeries, reducing surgical mortality from 20.8% to 5% and lower, increasing post-operative false lumen closing rate from 40% to over 95% and reducing re-op rate from 30% to 10% and lower[1]. Currently, Sun’s procedure is widely applied in South America and other countries[4] and has became a standard surgical method for treatment of aortic dissection[5].

In addition, Prof.  Sun Lizhong has developed Chinese-specific Aortic Dissection refined categorization, establishing a Chinese Model for aortic disease diagnosis and treatment, spanning aortic dissection treatment strategy, clinical experience, long-term prognosis and outcome, which has achieved considerable international influence.

As explained by Prof. Sun Lizhong, at the start of the 21th century, the complexity of surgical technique and lack of education has led to inadequate and unbalanced development of aortic dissection sub-specialty. At the time, no more than 20 medical centers was independently capable of comprehensive treatment of aortic dissection, achieving less than 5000 surgeries across China, which great disparity in treatment strategy and outcome[3].

Having invented the Sun’s Procedure, Prof. Sun Lizhong and his team enthusiastically promoted the procedure. With incessant effort, Sun’s Procedure has been recognized by multiple cardiac surgery textbooks, testifying the outstanding capability of aortic surgery in China, marking the ascendency of Chinese Aortic Surgery to leading players on the global stage.  Sun’s Procedure has also been the topic of multiple speeches on The American Association for Thoracic Surgery (AATS) Annual Meeting, Huston Aortic Symposium, European Association for Cardio-Thoracic Surgery (EACTS) Annual Meeting and Asian Society for Cardiovascular and Thoracic Surgery (ASCVTS) Annual Meeting, and published original papers on Circulation and other journals.

According to Prof. Sun Lizhong, these recognitions marks the achievements of years of effort to promote Sun’s Procedure and proves the success of Chinese Model of aortic disease diagnosis and treatment. Synergizing top medical expert like Prof. Sun Lizhong, the creator of Sun’s Procedure, and the innovative idea of DeltaHealth Model, DeltaHealth Hospital has won significant social recognition, especially among the patients.

Development: a long way to go

The invention of Sun’s Procedure and the life-saving speed enabled by DeltaHealth Model are far from the end of the road. Prof. Sun reminds us, despite considerable improvement of great vessel disease prevention, control, treatment, academic research and clinical application in China, great challenges still lie ahead.

In view of materials, the quality of material limits the success rate of medical treatment, impacting the incidence of bleeding. Further investment is needed for research and development of new materials.

In view of clinical management, more delicate management across the clinical process is needed for continuous medical quality and safety improvement and homogenous medical service quality, enhancing patient satisfaction.

In view of clinical technology, further improvement of TAAR and Total aortic replacement is needed. These operations are particularly complex and challenging in the field aortic surgery, making them the golden standard of the skills of the team of aortic surgery. In addition to Sun’s Procedure, we hope to see the emergence of more surgical methods, for example, Zhang’s Procedure, Wang’s Procedure…

As the president elect of Chinese Society for Thoracic and Cardiovascular Surgery, Prof. Sun Lizhong and his peers will keep pushing the boundary of cardiac surgery in China, help more hospital build their cardiac surgery capacity and encourage more young surgeons to devote their career to the development of cardiac surgery, bringing help to more patients.

DeltaHealth Hospital will also devote to sharing its experience in and promoting its models of Great Vessel Surgery, contribute to the overall development of Great Vessel Surgery in China and close the medical gap in different parts of China.

References：

[1] 曹景颖, 朱俊明, 张宏家. 百年医心永向党——我国胸心血管外科学会的建设者 ［J］. 中国心血管病研究,2021,19(8):673-676

[2] 孙立忠, 李建荣. 我国 Stanford A 型主动脉夹层诊疗进展与挑战 ［J］. 中华外科杂志,2017,55(4):241-244

[3] 吕颖新，邢晓燕，孙立忠. 中国主动脉外科的领跑者——孙立忠教授 ［J］，首都医科大学学报，2020，41（5）：818-821

[4] 凌寒. 十年探索，铸成「孙氏手术」——访北京安贞医院心脏外科中心主任孙立忠教授 ［J］. 中国当代医药,2014,21(26):1-3

[5] 朱俊明, 乔晨晖, 刘志刚, 等. 主动脉术式中国专家共识——孙氏手术 ［J］. 中华胸心血管外科杂志,2021,37(5):270-273

[6] 刘志学. 强化学科协作，让 AAD 患者不再「命悬一线」［J］. 中国医药导报,2012,9(32):1-4

文章来源：健康界

图片来源：上海德达医院提供