The 22nd South China International Congress of Cardiology (“SCC”) was held in Guangzhou, China during August 7-14, 2021. Due to the impact of COVID-19, the SCC of this year was held “online” with a brand-new and unprecedented look. Eminent cardiovascular experts and scholars from China and other countries all over the world gathered via the cloud to discuss the hotspot issues.

This year's SCC was sponsored by Guangdong Medical Association, Guangdong Medical Doctor Association, and Guangdong Pharmaceutical Association, co-sponsored by the cardiovascular disease specialized committees of the southern provinces and cities in China and the cardiovascular disease colleges in Hong Kong, Macau and Taiwan, and undertaken by Guangdong Academy of Medical Sciences/Guangdong Provincial People’s Hospital, Guangdong Cardiovascular Institute and the publisher of the Prevention and Control of Cardiovascular Diseases. The previous theme of “Science, Innovation and Harmony” was carried over. A total of 578 papers were received before the congress.

The congress was furnished with 35 direct broadcasting rooms, holding 48 thematic academic forums, 25 thematic forums and 14 satellite meetings. There were up to 951 keynote speeches, 782 hosts, and 364 discussions and summaries. The congress had 218,401 total hits and 146,636 actual viewers. The congress comprehensively covered cardiology, cardiosurgery, pediatric cardiology, interventional cardiology, cardiac pacing and electrophysiology, hypertension and metabolic syndrome, cardiovascular imaging, cardiovascular preclinical medicine and laboratory medicine, and other cardiovascular related disciplines, being rich and practical in academic contents.

Qingshan Geng, Jimei Chen and Jiyan Chen served as hosts of the opening ceremony

The opening ceremony of the congress was held both online and offline, with Qingshan Geng, executive chairman of the SCC and secretary of the party committee of Guangdong Provincial People’s Hospital, Jimei Chen, president of the Guangdong Cardiovascular Institute, and Jiyan Chen, director of the Department of Cardiology, serving as the hosts of the offline opening ceremony.

Shuguang Lin, chairman of the SCC made a speech

Xueqing Yu, president of Guangdong Provincial People’s Hospital, first delivered a welcome speech on behalf of the sponsors. President Yu said, as the CPC Guangdong Provincial Committee and Guangdong Provincial Government proposed to construct high-level hospitals, Guangdong Provincial People’s Hospital and Guangdong Cardiovascular Institute have made remarkable development achievements in recent years. The support of the government and people, and the generous help of experts and scholars have given them more resources, a bigger platform and greater diligence to achieve the construction of a high-level hospital. He called on all sectors of society to assist in the construction of healthy China for the benefit of all people.

Several leaders and experts made speeches online, including Shuguang Lin, president of Guangdong Medical Doctor Association, Yixian Chen, president of Hong Kong College of Cardiology, Yaling Han, chairman of Chinese Society of Cardiology, Shengshou Hu, director of National Center for Cardiovascular Diseases, Junbo Ge, president of Chinese College of Cardiovascular Physicians, Qingfeng Xu, deputy director of Health Commission of Guangdong Province and director of Traditional Chinese Medicine Bureau of Guangdong Province, and Zhibin Yao, president of Guangdong Medical Association. They all highly affirmed the SCC, and considered the holding of the 22nd SCC as a substantial move for Guangdong Provincial People’s Hospital to implement its responsibilities to promote and strength academic exchanges and carry out international cooperation as a national regional medical center for cardiovascular diseases. They called on the majority of cardiovascular disease experts to conduct in-depth research on the COVID-19 and make due contribution to the health of people around the world. They placed great expectations for the congress and hoped that the prevention, treatment and research of cardiovascular diseases can be pushed to a new height through study and exchange to serve healthy Guangdong and healthy China.

On the International Cardiovascular Medical Forum of SCC, Michael Tong, MD from Cleveland Medical Center of the United States gave a keynote speech entitled Surgical Treatment for Chronic Thromboembolic Pulmonary Hypertension. The speech conveyed new techniques and ideas to the attendees from various aspects such as the formation, diagnosis, treatment, and prognosis of chronic thromboembolic pulmonary hypertension.

The presentation of Prof. Simin Liu from Brown University introduced the prevention and treatment of cardiovascular and metabolic diseases from the background of establishing cardiovascular and metabolic diseases with modern epidemiology, the current situations of cardiovascular and metabolic diseases, to the prevention and control strategies for cardiovascular and metabolic diseases with systematic epidemiological studies, compared the situations in China and the United States, and cited the successful cases of PCSK9 inhibitor, an integrated implementation framework consisting of diagnosis, treatment and prevention. His multi-dimensional thinking and discussion are very worthy of learning and reference.

Prof. Junbao Du from Peking University First Hospital gave a speech entitled Progress in Diagnosis and Treatment of Syncope in Children. His research results were included in the Guidelines for Diagnosis of Syncope in Children promulgated by the Chinese Medical Association, and some of the core contents are incorporated in the relevant diagnosis and treatment guidelines in Europe, the United States, Germany and Canada, and listed as required knowledge for pediatricians in some countries. The diagnostic conditions for neurally-mediated syncope in children proposed by him have now become the criteria for syncope patients in international studies…The series of results have led the clinical research in China on syncope in children to be among the world leaders.

On August 14, 2021, on the 22nd South China International Congress of Cardiology, the Guangdong Federation of Cardiovascular Disease Prevention and Rehabilitation Professional Committee of China Heart Federation was established. A total of 80 units and more than 360 medical professionals joined the federation, covering cardiovascular departments in almost all public hospitals in Guangdong Province. Dayi Hu, Xiaoping Meng, Qingshan Geng, Jiyan Chen, Ning Tan, Lan Guo, Huan Ma and other experts participated in online and offline meetings. By voting, the meeting elected 296 members of the Guangdong Federation, 55 standing members, 12 vice chairmen and one chairman. Prof. Qingshan Geng was elected as chairman of the Guangdong Federation, and Dr. Huan Ma as secretary of the Federation. Nearly 10,000 medical professionals witnessed the establishment process of the federation online.

Qingshan Geng, chairman of the new federation and secretary of the party committee of Guangdong Provincial People’s Hospital, introduced the future work plan of the federation at the inaugural meeting. At present, only some member units have cardiovascular specialty with cardiac rehabilitation, and we will strive to achieve full coverage in the future. The federation will promote a hierarchical certification [three levels including demonstration unit (demonstration site), construction unit and constructing unit]. The federation plans to conduct health economics evaluation, cohort studies and cross-sectional surveys on whether to conduct cardiac rehabilitation, form academic results, and provide evidence for the benefits of cardiac rehabilitation to be the basis of government decisions related to health care reform. He also pointed out that the construction of a cardiac rehabilitation subspecialty requires a “two-step approach”. The first step is to establish a narrowly defined cardiac rehabilitation subspecialty to spread the knowledge and skills of cardiac rehabilitation to the entire department of cardiology and cover cardiac patients; the second step is to achieve full coverage of cardiac surgery (especially perioperative patients) and pediatric cardiology. The establishment of a cardiac rehabilitation subspecialty is the focus of the moment.

Prof. Qingshan Geng also innovatively proposed the “12345” strategy for cardiac rehabilitation work.

“1” is the overall integration of medical care to promote the health of all people;

“2” is the online and offline combination, providing education for doctors and advocating healthy lifestyles to patients online to ultimately achieve universal access to resources, and strengthening clinical care, teaching and scientific research, and academic conference organization offline;

“3” is the three combinations, combination of clinical medicine and psychology, of clinical medicine and nutrition, and of clinical medicine and rehabilitation medicine;

“4” is the “four cornerstones for health”, i.e. “rational diet, moderate exercise, stop smoking and refrain from drinking, and psychological balance”;

“5” is five prescriptions, namely, public psychological prescription, public nutrition prescription, exercise prescription, sleep prescription, and behavior prescription. Among them, the focus of behavior prescription is to promote lifestyle changes.

The 1st International Summit of Endoscopic Cardiac Surgery: Endoscope Connects the Big World

On August 14, 2021, the 1st International Summit of Endoscopic Cardiac Surgery was successfully held online during SCC. 21 minimally invasive cardiac surgeons from 7 countries and across the Taiwan Strait expressed their views on the development and prospect of minimally invasive cardiac technique to jointly promote the progress of minimally invasive surgery, including Prof. Chunsheng Wang from Zhongshan Hospital affiliated to Fudan University, Prof. Patrick Perier from Cardiovascular Center Bad Neustadt, Germany, Prof. Huiming Guo from Guangdong Provincial People’s Hospital, Prof. Zhe Zheng from Fuwai Hospital affiliated to Chinese Academy of Medical Sciences, Prof. Joseph Lamelas from the Medical Center of University of Miami, Prof. Mattia Glauber from the department of cardiac surgery at Sant' Ambrogio Clinic, Milan, Italy, Prof. Joseph Zacharias from Blackpool Victoria Hospital, the United Kingdom, Prof. Antonios Pitsis from Cardiac Medical Center at Thessaloniki, Greece, Prof. Lai Wei from Zhongshan Hospital affiliated to Fudan University, Prof. Toshiaki Ito from Red Cross Nagoya Daiichi Hospital, Japan, Prof. Yong Cui from Zhejiang Provincial People’s Hospital, and Prof. Naixin Ji from National Taiwan University College of Medicine, etc. More than 15,000 viewers watched the summit online.

There were hundreds of discussions on the hot issues such as the advantages and disadvantages of SAVR, Mini-SAVR and TAVR. Prof. Joseph Lamelas argued that TAVR technique faces many challenges in terms of valve durability, risk of reoperation, and survival rate at early and later stages before it is available to low-risk patients. Prof. Mattia Glauber believed that minimally invasive aortic valve replacement benefits patients in terms of perioperative mortality, time of intensive care, time of hospital stay, and time of intubation. Prof. Shengli Jiang mentioned that both minimally invasive endoscope techniques and interventional techniques should be based on the core benefits of the patients. Prof. Lai Wei suggested that age and economic situation are important factors influencing patient selection, and how to choose is ultimately a matter of individualized treatment for the patient, which requires joint decision making between the doctor and the patient.

At present, there is still a clinical controversy about the “indications with the application of pericardial patches and prosthetic rings for dredging of left ventricular outflow tract obstruction”, on which Prof. Huiming Guo and Prof. Shengli Jiang put forward their personal opinions and finally reached a consensus with many experts. During the meeting, Prof. Huiming Guo from the Cardiovascular Institute of Guangdong Provincial People’s Hospital pointed out that the interventional techniques for cardiac valves has developed rapidly in recent years and bloomed in adult cardiac surgery treatment in connection with conventional surgery and endoscopic surgery; the cardiac endoscope technique is irreplaceable and has a bright prospect.

Macrovascular Disease Forum: Follow up with Academic Frontiers and Enhance the International Influence of the Specialty

The SCC Macrovascular Disease Forum has been the top annual academic event in this specialty. The forum was presided over and organized by Director Ruixin Fan and Director Tucheng Sun of Guangdong Provincial People’s Hospital. Leading experts and scholars from 13 well-known medical institutions such as McGovern Medical School of the United States, Kobe University Hospital of Japan, Shanghai Delta Hospital, Fuwai Hospital affiliated to Chinese Academy of Medical Sciences, Zhongshan Hospital affiliated to Fudan University, Guangdong Provincial People’s Hospital, and others showed new achievements in clinical prevention and treatment of aorta-related diseases, promote simplified surgical techniques, carry out inter-regional collaboration, focus on hot and difficult topics, lead and promote the progress and innovation in clinical diagnosis and treatment and scientific research of macrovascular surgical diseases to make contributions to enhance the international influence of Chinese vascular surgery.

At the meeting, Prof. Shaofeng Zhou from McGovern Medical School started with a very interesting question: For patients with chronic renal insufficiency who undergo aortic surgery between stages I and V, is it true that the worse the stage, the worse the outcome? Surprisingly, the data showed that stage IV patients had worse outcomes than stage V patients. She also addressed the impact of transfusion on aortic surgery, and graphically summarized that we need to treat every patient as a JW (note: Jahowa Witness, rejecting all forms of transfusion), i.e. minimizing transfusion and preserving autologous blood.

Prof. Lizhong Sun, a leading figure in the macrovascular discipline in China, presented his experience in thoracoabdominal aortic replacement and pointed out several key points that affect the difficulty of surgery with countermeasures, such as proximal and distal neoplasia neck size, presence of stented elephant trunks, and presence of endoleaks. Prof. Cuntao Yu announced his unpublished mid-term follow-up results of integrated sutureless stents at the meeting, which inspired his peers for the mortality and complication rates that were much lower than the currently reported results of Type-A dissection treatment at home and abroad. Prof. Chunsheng Wang gave a meticulous interpretation of the latest AATS 2021 guidelines on surgical treatment of Type-A aortic dissection. Prof. Yutaka Okita presented a wonderful presentation on the surgical treatment of aortic-esophageal fistula occurring after aortic TEVAR surgery, shared everything from the diagnosis of this complication to the surgical details, and the surgical video in particular was an eye-opener. Other scholars also introduced strategies for the diagnosis and treatment of Type-A aortic dissection, modification of traditional frozen elephant trunk surgery, protection of brain and organs, application of small incisions in the macrovascular field, treatment of intermural hematoma of the aorta, etc. Several foreign experts believed that China has done an excellent job in regionalization. The level of clinical macrovascular diagnosis and treatment in China has been recognized by international peers.

Several “Meaty” Forums Hotly Debated on Arrhythmia

Arrhythmia and cardiac electrophysiology, as important subspecialties of cardiovascular diseases, were hit at several sub-forums at the congress. Several renowned experts at home and abroad shared their experiences on new technologies in various specialized fields of arrhythmia and had lively discussions on various topics.

Due to the high prevalence of atrial fibrillation, the pathogenesis of atrial fibrillation is not very clear, and its treatment standards have still not reached unity. Led by Prof. Shulin Wu from Guangdong Provincial People’s Hospital, experts in the field of atrial fibrillation joined together to look at the changing indications for catheter ablation based on the latest guidelines for atrial fibrillation and carefully interpreted the documents, believing that atrial fibrillation treatment has entered the era of rhythm control. Director Xianhong Fang of Guangdong Provincial People’s Hospital led the discussion on the overall solution for atrial fibrillation.

At the forum on atrial arrhythmia, Director Hai Deng from Guangdong Provincial People’s Hospital shared the current situation and future of using mobile devices to monitor atrial fibrillation centered on the comprehensive management of atrial fibrillation. For the topic of catheter ablation of atrial fibrillation/atrial flutter, Dr. Huimin Chu from Ningbo First People’s Hospital shared pulse ablation, the latest therapeutic method. Other experts from Beijing, Shanghai, Zhejiang, Wuhan and other parts of China introduced the technical difficulties and hot spots about high-density mapping of atrial fibrillation, the modified “2C3L” ablation technique, and ethanol infusion into the vein of Marshall. For long-range persistent atrial fibrillation, which is the most difficult to cure, experts in cardiology and cardiac surgery, such as Caihua Sang from Beijing Anzhen Hospital, Changfa Guo from Zhongshan Hospital affiliated to Fudan University, Zhe Zheng from Fuwai Hospital affiliated to Chinese Academy of Medical Sciences, and Huiming Guo and Yumei Xue from Guangdong Provincial People’s Hospital jointly discussed and explored new therapeutic methods.

Due to the ethnic reason, the incidence of ventricular arrhythmia is significantly higher in China than abroad. For “idiopathic ventricular arrhythmia”, the forum not only shared the mapping and ablation of common parts of origin, but also shared the mapping and ablation strategies for scare and refractory parts. For “organic ventricular arrhythmia”, Director Qing Yang from West China Hospital affiliated to Sichuan University shared his experience in the puncture of the pericardium. At the forum on comprehensive management of organic ventricular tachycardia, a heated discussion was made on the comprehensive treatment of this disease. At the forum on new progress in the field of ventricular tachycardia, Director Hongtao Liao from Guangdong Provincial People’s Hospital shared progress in electrophysiological mechanisms of organic ventricular tachycardia; Director Xingpeng Liu from Beijing Chaoyang Hospital introduced a new technique of stereotactic therapy for ventricular tachycardia.