A 23-year-old male patient was diagnosed with congenitally corrected transposition of the great arteries (ccTGA) at the age of 3 during a routine physical examination. Due to the absence of significant symptoms, the patient was managed conservatively with follow-up without surgical treatment. He developed chest tightness one year prior to admission, with symptom exacerbation in the recent month. Echocardiography demonstrated significantly worsened morphological tricuspid regurgitation. The patient presented to Guangdong Provincial People’s Hospital for surgical evaluation. Given the patient’s age and clinical presentation, a totally thoracoscopic morphological tricuspid valve replacement was performed. Postoperative assessment showed good prosthetic valve function, with no regurgitation or paravalvular leakage; the electrocardiogram confirmed sinus rhythm without atrioventricular block. Extubation occurred within 12 hours postoperatively, and the patient was transferred from the intensive care unit (ICU) on postoperative day 2. At the three-month follow-up, the patient was asymptomatic and had resumed normal activities. This report describes the first case of a totally thoracoscopic morphological tricuspid valve replacement in a ccTGA patient in China. This initial experience suggests that the totally thoracoscopic approach for morphological tricuspid valve replacement in ccTGA patients is a feasible, safe, and effective minimally invasive option associated with rapid recovery.
ObjectiveTo evaluate the efficacy of video-assisted thoracoscopic sleeve lobectomy in the treatment of central non-small cell lung cancer.MethodsThe clinical data of 105 patients with central non-small cell lung cancer who underwent sleeve lobectomy surgery in the Second Hospital of Shanxi Medical University and Shanxi Cancer Hospital from December 2014 to December 2019 were retrospectively analyzed, including 83 males and 22 females, with an average age of 57.4 (32.6-77.8) years and weight of 62.5 (52.4-79.1) kg. Thirty-five patients received video-assisted thoracoscopic sleeve lobectomy (a group A), and 70 patients received traditional thoracotomy sleeve lobectomy (a group B). The operation time, intraoperative blood loss, number of lymph node dissection, postoperative complication rate, early postoperative mortality, total thoracic drainage volume at 24 hours, time of indwelling chest tube after operation, pain score at 24 hours after operation, postoperative hospital stay, postoperative short-term (1 month, 6 months and 1 year) quality of life score and postoperative 3-year survival rate of two groups were compared.ResultsThere was statistical difference in the operation time (228.1±24.7 min vs. 175.0±23.7 min, P=0.02), postoperative complication rate (28.6% vs. 34.3%, P=0.04), postoperative pain score at 24 h (3.6±3.5 points vs. 5.9±2.0 points, P=0.03) and postoperative indwelling chest tube time (5.0±2.9 d vs. 8.4±2.1 d, P=0.04) between the two groups. There was no statistical difference in the intraoperative blood loss (182.5±36.9 mL vs. 189.8±27.5 mL, P=0.34), number of lymph node dissections (11.1±2.6 vs. 12.3±1.9, P=0.49), early postoperative mortality (2.9% vs. 4.3%, P=0.31), total thoracic drainage volume at 24 h after surgery (346.8±91.1 mL vs. 329.8±101.4 mL, P=0.27), postoperative hospital stay (7.9±4.2 d vs. 8.5±3.4 d, P=0.39) and 3-year postoperative survival rate (68.6% vs. 72.9%, P=0.82) between the two groups.ConclusionVideo-assisted thoracoscopic sleeve lobectomy for the treatment of central non-small cell lung cancer is safe and feasible. Compared with traditional thoracotomy for sleeve lobectomy, fewer postoperative complications occur, body recovers faster and the quality of life is higher within the postoperative 6 months. Besides, the 3-year survival rate can achieve similar oncological prognosis results.
Abstract： Objective To investigate the effect of singledirection lobectomy plus systematic lymphnode dissection for primary nonsmall cell lung cancer (NSCLC) in the early stage by videoassisted thoracic surgery (VATS). Methods We retrospectively analyzed the clinical data of 89 patients who received VATS lobectomy plus systematic lymphnode dissection for earlystage primary NSCLC in the Second People’s Hospital of Chengdu between June 2006 and December 2009. Based on the operative approach, the patients were divided into two groups: VATSminithoracotomy group and singledirection lobectomy VATS group. In the former group, there were 46 patients, including 36 males and 10 females, with an age of 58.76±14.78 years. For patients in this group, minithoracotomy was carried out assisted by VATS. In the latter group, there were 43 patients, including 37 males and 6 females, with an age of 61.34±12.56 years, and singledirection lobectomy VATS was performed for patients in this group. Moreover, 42 patients undergoing routine posterior lateral open thoracotomy were chosen to form the control group (thoracotomy group, included 37 males and 5 females with an age of 56.30±15.59 years). The clinical features, such as operative time, operative blood loss, the number of systematic dissected lymph nodes, postoperative drainage quantity, postoperative complications and visual analogue scale (VAS) of chest pain were retrospectively analyzed to evaluate the early outcomes. Results No operative death occurred in all three groups. There were significant differences among the three groups in the postoperative drainage time (P=0.024), postoperative drainage quantity (P=0.019), operative blood loss (P=0.009), early outofbed activity time (P=0.031), and the incidence of cardiopulmonary complications (P=0.048). Compared with the VATSminithoracotomy group, the singledirection lobectomy VATS group was significantly lower or shorter (Plt;0.05) in postoperative drainage quantity (208.33±50.39 ml vs. 245.98±45.32 ml), operative blood loss (78.79±24.23 ml vs. 112.63±64.32 ml), and the early outofbed activity time (2.31±0.27 d vs. 3.56±0.31 d). The rate of using Dolantin in the control group was significantly higher than the other two groups (P=0.046, 0.007). The change of VAS score among the three groups after operation was also statistically significant (F=5.796, P=0.002). A total of 109 patients (37 in the VATSminithoracotomy group, 37 in the singledirection lobectomy VATS group, and 35 in the control group) were followed up after operation with a period of 2 to 48 months. Twentytwo patients were lost in the followup. There were 10, 9, and 8 deaths during the followup in the three groups respectively, and the median survival time was 40 months, 37 months, and 37 months respectively. There was no significant difference among the three groups in survival time (P=0.848). Conclusion VATS, especially VATS assisted single direction lobectomy and systematic lymphnode dissection for primary NSCLC in the early stage has the same surgical efficacy as the traditional open thoracotomy, and is minimally invasive, which contributes to a quick recovery. Consequently, it is a reliable approach for lung cancer in the early stage.
ObjectiveTo examine the differences between totally thoracoscopic surgery and median sternotomy in scope of trauma, postoperative recovery and postoperative complications. MethodsWe retrospectively analyzed the clinical data of 331 patients with cardiac myxoma in our hospital between January 2001 and November 2015. The patients were devided into 2 groups by the different methods of operation:a totally thoracoscopic surgery group including 196 patients with 71 males and 125 females at a mean age of 50 (42.00-57.50) years, and a median sternotomy group including 135 patients, with 53 males and 82 females at a mean age of 52 (38.00-61.00) years. The clinical records of the two groups were compared in scope of trauma, postoperative recovery, and postoperative complications. ResultsThere was shorter time in breathing machine and ICU time (P<0.001), and fewer volume in blood transfusion, blood loss (P<0.001) in the totally thoracoscopic surgery group. There was less pain and postoperative complications (P<0.001) in the totally thoracoscopic surgery group. The aortic clamp time in the totally thoracoscopic surgery group was not significantly different compared with that in the median sternotomy group (P=0.15) While cardiopulmonary bypass time was shorter in the median sternotomy group (P<0.001). ConclusionTotally thoracoscopic surgery is a safe and reliable method in treating cardiac myxoma. Our results suggest that totally thoracoscopic surgery has the advantage of fewer blood loss, blood transfusion, and postoperative complications compared with median sternotomy surgery. Totally thoracoscopic surgery leads to earlier recovery and less pain.
ObjectiveTo evaluate the early and mid-term outcomes of total thoracoscopic Box Lesion radiofrequency ablation in patients with atrial fibrillation.MethodsThe clinical data of 31 patients with atrial fibrillation who underwent total thoracoscopic Box Lesion radiofrequency ablation between November 2011 and March 2018 at the Department of Cardiac Surgery in our hospital were retrospectively analyzed, including 23 males and 8 females at an average age of 66.17±8.32 years. All patients did not have concomitant severe organic heart disease which required surgical intervention.ResultsThere were 20 patients with paroxysmal atrial fibrillation, 8 with persistent atrial fibrillation, and 3 with long-standing persistent atrial fibrillation. Twenty-nine patients got the 3-year follow-up, and 2 patients were lost to the follow-up 6 months after the surgery. The procedure was successfully performed in all patients, with an average operation time of 113.00±26.00 min. There was no perioperative death or related complication. All patients were restored to sinus rhythm immediately after surgery. Five patients got atrial fibrillation during postoperative hospitalization, which reverted to sinus rhythm after electrical cardioversion. The rate of sinus rhythm maintenance was 62.9%, 55.9% and 52.4% in postoperative 1, 2 and 3 years, respectively. No patient died during the period, and no procedure-related complication was observed.ConclusionTotal thoracoscopic Box Lesion radiofrequency ablation effectively shortens operation time, and reduces surgical trauma and procedure-related complications, meanwhile, ensures the surgical outcomes.
ObjectiveTo compare the surgical effects of totally thoracoscopic and thoracoscopic-assisted small incision for left atrial appendage clipping. Methods The clinical data of patients who underwent left atrial appendage clipping surgery via totally thoracoscopy or thoracoscopic-assisted minimally invasive small incision from November 2018 to March 2022 in Beijing Tiantan Hospital were retrospectively analyzed. According to the surgical approach, they were divided into a totally thoracoscopic group and a small incision group. The clinical results were compared between the two groups. ResultsA totoal of 41 patients were enrolled, including 30 males and 11 females, with an average age of 66.6±6.1 years. There were 23 patients in the totally thoracoscopic group and 18 patients in the small incision group. The CHA2DS2-VASc score was 4.5±1.1 points, and HAS-BLED score was 3.7±1.5 points. No death occured in the whole group. There was no statistical difference between the two groups in terms of operation time, chest complications, successful rate of closure of the left atrial appendage, residual length of the left atrial appendage, or displacement of the atrial appendage clip (P>0.05). The total drainage volume in the totally thoracoscopic group was less than that in the small incision group, and the difference was statistically significant (P=0.031). The median follow-up time was 10 (1-30) months, during which there was 1 patient of stroke and 1 patient of left atrial thrombus in both groups. ConclusionTotally thoracoscopic left atrial appendage clipping is less invasive than thoracoscopic-assisted minimally invasive small incision surgery and does not increase the risk of surgical complications.
ObjectiveTo explore the effectiveness and safety of the improved approach of intraoperative temporary epicardial pacing lead implantation in complete video-assisted cardiac surgery. Method We included 50 cardiac patients with video-assisted cardiac surgery indications in our hospital from September 2013 to November 2013. According to approach to placing intraoperative temporary epicardial pacing lead, the patients were divided into two groups including an improved group (30 patients with 17 males and 13 females at age of 45.6±15.7 years) and a traditional group (20 patients with 12 males and 8 females at age of 44.2±17.7 years). Time of temporary epicardial pacing lead implantation, potential perioperative complications, and clinical data of intraoperation and postoperation were compared between the two groups. Result All the patients survived during perioperative period. No intraoperative bleeding, no pericardial tamponade, no infection caused by pacing wires, as well as no relevant postoperative complications occurred. Implantation time in the improved group is shorter than that in the traditional group (P<0.001). No patient had been found situations like moderate pericardial effusion, as well as pacing leads shifting during the following-up period. ConclusionThe improved approach has shorten the implantation time, which is simpler and more effective. No patient suffers from postoperative complications during short-term following-up. But the effect in long-term following-up period is still contentious.
ObjectiveTo examine the safety, efficacy and durability of totally endoscopic minimally invasive (TEMI) mitral valve repair in Barlow’s disease (BD). MethodsA retrospective study was performed on patients who underwent mitral valve repair for BD from January 2010 to June 2021 in the Guangdong Provincial People’s Hospital. The patients were divided into a MS group and a TEMI group according to the surgery approaches. A comparison of the clinical data between the two groups was conducted. ResultsA total of 196 patients were enrolled, including 133 males and 63 females aged (43.8±14.9) years. There were 103 patients in the MS group and 93 patients in the TEMI group. No hospital death was observed. There was a higher percentage of artificial chordae implantation in the TEMI group compared to the MS group (P=0.020), but there was no statistical difference between the two groups in the other repair techniques (P>0.05). Although the total operation time between the two groups was not statistically different (P=0.265), the TEMI group had longer cardiopulmonary bypass time (P<0.001) and aortic clamp time (P<0.001), and shorter mechanical ventilation time (P<0.001) and postoperative hospitalization time (P<0.001). No statistical difference between the two groups in the adverse perioperative complications (P>0.05). The follow-up rate was 94.2% (180/191) with a mean time of 0.2-12.4 (4.0±2.4) years. Two patients in the MS group died with non-cardiac reasons during the follow-up period. The 3-year, 5-year and 10-year overall survival rates of all patients were 100.0%, 99.2%, 99.2%, respectively. Compared with the MS group, there was no statistical difference in the survival rate, recurrence rate of mitral regurgitation, reoperation rate of mitral valve or adverse cardiovascular and cerebrovascular events in the TEMI group (P＞0.05). ConclusionTEMI approach is a safe, feasible and effective approach for BD with a satisfying long-term efficacy.