The current status of cardiovascular disease worldwide Entering the 21st century, cardiovascular disease has brought new and serious challenges to mankind. The World Health Organization has analyzed the major diseases that currently pose a threat to human health, and cardiovascular disease has the highest mortality rate, with about 17 million deaths per year due to cardiovascular disease worldwide, making it a global public health problem. The current situation and development trend of cardiovascular disease in China The prevalence of cardiovascular disease in China is in a continuous rise. One out of every five adults suffers from cardiovascular disease. In 2011, cardiovascular disease accounted for 41% of all deaths among urban and rural residents in China, ranking first among all causes of death. The mortality rate of cardiovascular disease among rural residents is increasing faster than that of urban residents. The 2011 World Bank projections on cardiovascular diseases in China: (1) The number of patients including cardiovascular diseases among people over 40 years old will increase 2-3 times in the next 20 years, and its rapid growth will be mainly concentrated in the next 10 years. (2) The burden of cardiovascular-related disease (life years lost) is projected to increase by nearly 50% from 2010 to 2030. The share of cardiovascular diseases (including heart attacks and strokes) will exceed 50%. Of these, stroke poses the greatest risk to the health and lives of patients. (3) China’s cardiovascular disease mortality rate is higher than that of Japan and developed countries in Europe and the United States, and the stroke mortality rate is four to six times higher than that of Japan, the United States and France. (4) Without an improved response, cardiovascular disease, stroke, and diabetes will cost China$550 billion in economic losses between 2005 and 2015. Meanwhile, the total number of cardiac surgeries in mainland China in 2010 was 170,491, of which only 1% were treated with minimally invasive surgery, compared to about 10% in Western countries during the same period. Therefore, minimally invasive cardiovascular surgery in China has great potential for development. Advantages of Minimally Invasive Cardiovascular Surgery Traditional cardiac surgery requires a median sternotomy incision, which is 20-30 cm long, traumatic, with a lot of bleeding and slow recovery, and the patient often needs to be hospitalized for more than a week after surgery, and most patients need to use blood transfusion products. Minimally invasive cardiovascular technology has become the development trend of cardiovascular surgery. The advantages of minimally invasive surgery over traditional surgery, while achieving the same results as traditional surgery, are: (1) Reducing or eliminating the trauma to the body caused by extracorporeal circulation. (1) Reducing or eliminating the trauma caused by extracorporeal circulation, including: (1) improved extracorporeal circulation techniques, such as establishing extracorporeal circulation without opening the chest; (2) non-external circulation techniques, such as coronary artery bypass grafting without extracorporeal circulation; (2) reducing or even avoiding transthoracic incisions. For example, various types of partial sternotomy, small parasternal incision, lateral chest wall incision, and percutaneous intracavitary treatment can also be done through thoracoscopy; (3) reduce the trauma of manual operation and replace it with more precise instrumentation. (4) Most of the patients do not need blood transfusion, the postoperative recovery is fast, the hospital stay is short, the postoperative pain is reduced, the patient’s thoracic stability is not destroyed, and the future upper limb movement and physical activity are not affected; (5) good cosmetic effect. At present, China has been able to carry out most of the minimally invasive cardiovascular surgeries, and the technology of minimally invasive cardiovascular surgery is basically synchronized with foreign countries. (1) Direct vision minimally invasive small incision surgery Small incisions include median small incision, parasternal small incision and lateral chest wall small incision. Minimally invasive surgical incisions are about 4-5 cm, and most cardiac surgeries can be performed without cutting the sternum or ribs with the help of specially designed surgical instruments, including valve surgery (single valve, double valve replacement and/or repair + radiofrequency ablation), corrective surgery for precordial disease, coronary artery bypass grafting for single and multiple vessel lesions, radiofrequency ablation for atrial fibrillation, etc. Zhongshan Hospital is currently a more mature hospital in performing direct vision minimally invasive small incision cardiac surgery. Under the leadership of Director Chunsheng Wang, minimally invasive techniques have been routinely used for valve disease, including mitral valve replacement or repair, aortic valve replacement or repair, and valve surgery + radiofrequency ablation. Some congenital heart diseases, such as atrial septal defect and ventricular septal defect, as well as some patients who cannot tolerate large open-heart surgery or require minimally invasive surgery, can choose minimally invasive surgery. (2) Non-extracorporeal cardiac surgery Non-extracorporeal cardiac surgery is mainly represented by non-extracorporeal cardiac non-stop coronary artery bypass surgery, including: (1) OPCAB under median incision and non-extracorporeal circulation; (2) MIDCAB under small incision and non-extracorporeal circulation, etc. This method has become a new trend of myocardial blood flow reconstruction in cardiovascular surgery. (3) TV thoracoscopic-assisted cardiac surgery TV thoracoscopic cardiac surgery includes thoracoscopic-assisted and total thoracoscopic cardiac surgery, which is a more affirmative minimally invasive surgery. At present, some cardiac surgeries can be performed through thoracoscopy, such as mitral or tricuspid valve repair or replacement under extracorporeal circulation, atrial septal defect repair under extracorporeal circulation, pericardial opening and drainage, cardiac pacing electrode installation, and minimally invasive surgical atrial fibrillation ablation. Television thoracoscopic cardiac surgery is considered another major technological revolution in the field of cardiac surgery since the introduction of extracorporeal circulation, and is a representative procedure of modern minimally invasive cardiac surgery. (4) Surgery done by robotic arm – robotic surgery Robotic surgery is a robot operated by the surgeon off the table, through the chest wall perforation, the robot arm into the patient’s chest cavity to complete cardiac surgery, can be used for atrial septal defect repair, partial septal defect repair, mitral valve replacement or molding surgery, single anterior descending branch or diagonal branch of coronary artery bypass grafting, etc. Few hospitals in China can routinely perform this procedure, and Zhongshan Hospital in East China is the earliest and most developed. (5) The application of interventional methods in cardiac surgery Minimally invasive surgery combined with interventional techniques has gradually become a new method of cardiovascular surgery. It is mainly applied to the surgical treatment of coronary heart disease and aortic disease. The use of robotic surgery to complete the left internal mammary artery-anastomosis of the anterior descending branch, combined with percutaneous catheter interventions to deal with gyral branch or right coronary lesions, has been proven to be effective and less invasive by a larger body of literature. Directions for research and development of minimally invasive cardiovascular surgery In summary, promising results have been achieved in the application and research of minimally invasive cardiovascular surgery, but there are still many clinical problems that need to be solved. The research on the following contents will be of great significance for the development of minimally invasive cardiac surgery: ① Research on the trauma mechanism of cardiac surgery can provide a theoretical basis for further reduction of trauma; ② Research on myocardial protection can help reduce myocardial trauma during surgery; ③ Improvement of related surgical instruments and vascular stents can make the corresponding minimally invasive surgery easier; ④ Clarification of the indications for the surgical treatment of various cardiovascular diseases can facilitate the most reasonable minimally invasive treatment. ④ clarify the indications for surgical treatment of various cardiovascular diseases, which is conducive to the selection of the most reasonable minimally invasive treatment methods; ⑤ explore new minimally invasive treatment methods.