Cardiology: China’s Impact on Market Demand

In 2011, the combined cardiac surgery device markets of Japan, Australia, South Korea and China was valued at $443.3 million U.S. dollars. The market for cardiac surgery devices is growing in the Asia-Pacific region. The country with the fastest growing market for these devices is China. Their market will grow at a CAGR of 13% between 2011 and 2018. China’s rapid growth for cardiac surgery devices is attributed in part to its rapidly expanding economy. Another factor, which is driving the Chinese market, is the growing access of the public to medical professionals. This greater access is attributed to continuing improvements to the Chinese transportation infrastructure, which includes more roads and vehicles. Thus, those living in rural areas who have previously had limited access to healthcare options, are now within serviceable distances of hospitals.

There are a number of cardiac surgery devices that are set to grow in Asian countries. For example, artificial heart valves represent one of the largest market segments in the cardiac surgery device market, which is expected to grow in the near future. Heart valve replacements are either tissue-based or mechanical designs. Because there are significant advantages for using tissue heart valves over mechanical heart valves, the market for the former is slowly cannibalizing the latter. Also contributing to the rise of cardiac surgery procedures is the increasing presence of western foods in Asia. The increasing integration of high-fat diets into Asian cultures is leading to an increase in coronary artery bypass graft (CABG) procedures.

Coronary artery bypass graft (ABG) procedures can either be performed on-pump or off-pump. On-pump coronary artery bypass (ONCAB) procedures require cardiopulmonary bypass (CPB). CPB devices are also known as heart-lung machines. In contrast, off-pump coronary artery bypass (OPCAB) procedures are performed in the absence of CPB devices. Because the heart is still beating during OPCAB procedures, a higher level of skill is required from the physicians. To enhance precision and speed of OPCAB procedures, specialized devices are used. These devices aid in precision and speed, and promise reduced invasiveness over alternative procedures.

Tissue and Mechanical Heart Valve Markets are Growing Rapidly in China

China is experiencing rapid growth in almost all medical device markets. The cardiac surgery device market is no exception, with many segments within this market growing at double-digit rates. The rapid growth is a combined function of increasing prosperity, awareness, and access to healthcare facilities. Despite these driving factors, the Chinese government is aware that the market growth cannot be sustained in the long run. This is due to limited healthcare budgets.

In an attempt to counter their rapidly rising market, the government is entertaining the idea of implementing cost control for medical devices. Nevertheless, it is expected that the markets for both tissue heart valves and mechanical heart valves will grow. Tissue heart valves, which are also known as bioprosthetic valves, are harvested from human or animal donors. For the most part, animal donor valves which are referred to as allograft valves are used because they are vastly more plentiful. Tissue heart valves have significant advantages over mechanical valves including higher biocompatibility. Because of this advantage, the market for tissue heart valves is growing faster than for mechanical valves. However, tissue valves are much more expensive than their mechanical counterparts. This price discrepancy is driving the market for mechanical valves.

A drawback of mechanical valves is that implantation of these devices necessitates long-term follow-up therapy in the form of anticoagulants. The anticoagulants are required to prevent the formation of emboli, which could lead to death. A side-effect of the anticoagulant therapy is an increased propensity to bleed. Mechanical valves are also facing price erosion as a result of the growing market shares of domestic Chinese manufacturers who are able to produce high-quality variants of these devices. Moreover, the domestic players are able to market their devices at a lower price than the global market leaders for mechanical heart valves. Because of their lower price, accessibility and promise of long service, mechanical heart valves are more popular in terms of unit sales than tissue heart valves. In fact, the unit sales for mechanical heart valves are expected to grow at about 15% year over year from 2012 onwards.

CABG Procedures are Expected to Rise Across Asia

Heart disease is on the rise in Asia and among the Asian countries, Australia has one of the highest incidences of cardiac surgery procedures. This is not surprising because the Australian diet, which is tends to be high in fat, is more similar to European and North American standards than to their Asia-Pacific neighbors. In fact, the number of CABG procedures in Australia is similar to that of Japan, a country with almost six-times the number of people. Regardless of the number of procedures performed per country, the demand for CABG is expected to grow in Asia. Because of its relative simplicity and ubiquity, ONCAB is typically the more popular of the two main types of bypass procedures, the other being OPCAB. ONCAB is the traditional type of CABG procedure that is performed when the heart is stopped. The risk of complications resulting from ONCAB is low at about 1%. However, those with preexisting conditions such as obesity face a much higher rate of complications. To circulate the blood during the procedure, a heart lung machine is employed. The use of heart lung machines have been associated with elevated risk of stroke and impaired mental function.

OPCAB is the newer of the two main types of CABG procedures. Because of its novelty and certain advantages over ONCAB, the number of OPCAB procedures is growing faster than ONCAB across Asia. OPCAB procedures have additional complexity over ONCAB because the heart remains beating. This makes manipulation of grafts and placement of sutures more difficult. During OPCAB procedures, physicians immobilize a portion of the heart with a stabilizer. To assist the physician during the surgery, the heart is mechanically stabilized and held in position using specialized devices. In Japan, OPCAB has been quickly adopted. The medical community has recognized the advantages of this technique and OPCAB is considered the standard type for CABG procedures in Japan. The complexity of OPCAB procedures has led to the growth of other segments of the cardiac surgery device market such as anastomosis assist devices (AADs).

In time, growth in the number of CABG procedures will be limited by the increasing popularity of percutaneous coronary intervention (PCI) procedures. PCI procedures promise similar levels of effectiveness and lower invasiveness in comparison to CABG. Nonetheless, CABG is preferred when more than one coronary vessel is occluded or if the occlusion is considered significant.

The Growing Number of OPCAB Procedures Directly Affects Anastomosis Assist Devices

During CABG procedures, anastomoses are performed to restore continuity of blood flow through the graft. The traditional method of anastomosis requires clamping of the aorta and hand suturing the vessels together, a procedure which requires a great deal of skill and time. Not surprisingly, the difficulty of traditional suturing is compounded by the movement of a beating heart as in the case of OPCAB. To facilitate reproducible and fast anastomoses, AADs have been developed. The implementation of AADs has significantly reduced the difficulty of performing OPCAB, making this type of CABG procedure more accessible.

Medtronic Was the Leading Competitor for the Japanese, South Korean and Chinese Cardiac Surgery Device Markets.

In 2011, Medtronic was the overall leader in the Japanese, South Korean and Chinese cardiac surgery device markets. They were able to hold this position due to their strength in many segments of the market including the lucrative tissue and mechanical heart valve segments, where they are often the leading company. They also participated in the markets for AADS, ONCAB, OPCAB and to a lesser extent the cardiac ablation device segment.

Other major players in the cardiac surgery device market include Maquet, St. Jude Medical, Edwards Lifesciences, Biosense Webster, Sorin Group, Terumo Medical, Thoratec, HeartWare, Teleflex Medical, Boston Scientific and AtriCure. Maquet was a major player in the ONCAB, OPCAB, AAD and endoscopic vessel harvesting device segments. Edwards Lifesciences was involved for the most part in heart valve repair devices which include heart valve replacements and annuloplasty repair devices.

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Conclusion

China is experiencing growth in almost all medical device markets; however different variables dictate which segments are becoming less popular and which are growing quickly. Currently China is contributing to continued growth in artificial heart valves, CABG procedures, OPCAB Procedures and AADs. China’s rapidly increasing population will continue to influence and set trends for the entire Asia-Pacific Market. Chinese market dynamics should be considered and weighted heavily when making manufacturing decisions that pertain not only to China, but to Japan, Australia, and South Korea.

Bibliography

 “Asia-Pacific Markets for Cardiac Surgery Devices 2012,”  iData Research.For more information and a free synopsis of the  report, please contact at: [email protected]

“Chinese Markets for Cardiac Surgery Devices 2012,” iData Research. For more information and a free synopsis of the  report, please contact at: [email protected]
 

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Kamran Zamanian, PhD is president, CEO, and founding partner of iData Research Inc. He has spent more than 20 years working in the market research industry. He received his Bachelor of Science in engineering from the University of Dundee, and received his Master of Science and doctoral degrees from the University of Manchester in market research and technology. Contact him at [email protected]