Objective To monitor surgical quality and analyze learning curve of minimally invasive totally thoracoscopic cardiac surgery. Methods We retrospectively analyzed the clinical data of 150 consecutive patients who underwent minimally invasive totally thoracoscopic cardiac surgery in the Guangdong General Hospital between January 2013 and December 2015. There were 60 males and 90 females at age of 43.1 years. There were 60 patients with atrial or ventricular septal defect repair, 12 patients with cardiac tumor resection, 53 patients with mitral valve replacement and 25 patients with mitral valve repair. According to the surgical sequence, all the patients were divided into 3 groups including a group A, group B, and group C with 50 patients in each group (every 10 patients as a sequence, every 5 sequence as a group). Surgical outcomes were compared among the 3 groups, and surgical quality was analyzed with descriptive statistics. Results Surgical failure rate was 6.7% (10/150). There was no in-hospital mortality. Aortic cross-clamp time, cardiopulmonary bypass time and duration of mechanical ventilation, duration of ICU stay, duration of hospital stays of the group C were significantly shorter than those of the group A and group B. Analysis showed a significant learning curve effect in totally thoracoscopic cardiac surgery. When surgical cases reached about 100 cases, cardiopulmonary bypass and aortic cross-clamp time was shorter than the average value stably. Conclusion Totally thoracoscopic cardiac surgery is safe and reliable. For the beginners, it needs about 100 patients of surgery to master the totally thoracoscopic cardiac surgery.
Minimally invasive cardiac surgeries are the trend in the future. Among them, robotic cardiac surgery is the latest iteration with several key-hole incision, 3-dimentional visualization, and articulated instrumentation of 7 degree of ergonomic freedom for those complex procedures in the heart. In particular, robotic mitral valve surgery, as well as coronary artery bypass grafting, has evolved over the last decade and become the preferred method at certain specialized centers worldwide because of excellent results. Other cardiac procedures are in various stages of evolution. Stepwise innovation of robotic technology will continue to make robotic operations simpler, more efficient, and less invasive, which will encourage more surgeons to take up this technology and extend the benefits of robotic surgery to a larger patient population.
ObjectiveTo summarize the experience of totally thoracoscopic cardiac surgery (TTCS) for atrial septal defect.MethodsClinical data of 442 patients undergoing TTCS for atrial septal defect from May 2008 to December 2018 in Shanghai Yodak Cardiothoracic Hospital was analyzed retrospectively. There were 149 male and 293 female patients, aged 3-74 (29.1±14.3) years. Surgical procedures were performed through 3 ports at the right chest wall.ResultsAll the operations were completed successfully. Mean operative time was 1.5-4.6 (2.2±0.3) h. The mean extracorporeal circulation and aortic cross-clamp time was 28-118 (55.9±13.3) min and 8-78 (21.5±10.2) min, respectively. Mechanical ventilation and intensive care unit stay time was 3.5-122.0 (8.1±7.4) h and 13-141 (20.7±10.2) h, respectively. Postoperation drainage volume was 70-1 280 (251.8±131.5) mL. The hospital stay was 4-16 (7.1±1.4) d. Intraoperative and postoperative complications occurred in 15 patients (3.3%). The mean follow-up time was 1-128 (67.6±33.3) months, and during the period, there were 25 patients of atrial fibrillation, 25 patients of mild-moderate tricuspid valve incompetence, 1 patient of moderate tricuspid valve incompetence. There was no reoperation or residual shunt during the period of follow-up. And the heart function was improved.ConclusionTTCS is a feasible, safe and minimal invasive approach for patients with atrial septal defect and has good short to medium-term outcomes.
Totally thoracoscopic surgery is a branch of minimally invasive cardiac surgeries, and its operational indicators are expanding with the development of the medical and imaging devices compared with median sternotomy and other minimally invasive cardiac surgeries (such as thoracoscope-assisted small incision surgery and robotic surgery). The learning curve is significantly shortened through the professional technique training. Totally thoracoscopic cardiac surgery has many advantages, such as minor trauma, few serious complications, fast recovery, high patient acceptance and being suitable to our country's current situation. Therefore it will be one main direction of minimally invasive cardiac surgery. This article mainly introduced the current status of totally thoracoscopic technology in the field of cardiac surgery in China.
Objective To explore the effect of preoperative hypothyroidism on postoperative cognition dysfunction (POCD) in elderly patients after on-pump cardiac surgery. Methods Patients who were no younger than 50 years and scheduled to have on-pump cardiac surgeries were selected in West China Hospital from March 2016 to December 2017. Based on hormone levels, patients were divided into two groups: a hypo group (hypothyroidism group, thyroid stimulating hormone (TSH) >4.2 mU/L or free triiodothyronine 3 (FT3) <3.60 pmol/L or FT4 <12.0 pmol/L) and an eu group (euthyroidism group, normal TSH, FT3 and FT4). The mini-mental state examination (MMSE) test and a battery of neuropsychological tests were used by a fixed researcher to assess cognitive function on 1 day before operation and 7 days after operation. Primer outcome was the incidence of POCD. Secondary outcomes were the incidence of cognitive degradation, scores or time cost in every aspect of cognitive function. Results No matter cognitive function was assessed by MMSE or a battery of neuropsychological tests, the incidence of POCD in the hypo group was higher than that of the eu group. The statistical significance existed when using MMSE (55.56% vs. 26.67%, P=0.014) but was absent when using a battery of neuropsychological tests (55.56% vs. 44.44%, P=0.361). The incidence of cognitive deterioration in the hypo group was higher than that in the eu group in verbal fluency test (48.15% vs. 20.00%, P=0.012). The cognitive deterioration incidence between the hypo group and the eu group was not statistically different in the other aspects of cognitive function. There was no statistical difference about scores or time cost between the hypo group and the eu group in all the aspects of cognitive function before surgery. After surgery, the scores between the hypo group and the eu group was statistically different in verbal fluency test (26.26±6.55 vs. 30.23±8.00, P=0.023) while was not statistically significant in other aspects of cognitive function. Conclusion The incidence of POCD is high in the elderly patients complicated with hypothyroidism after on-pump cardiac surgery and words reserve, fluency, and classification of cognitive function are significantly impacted by hypothyroidism over than other domains, which indicates hypothyroidism may have close relationship with POCD in this kind of patients.
Atrial fibrillation (AF) is one of the most common complications after cardiac surgery. The existing treatment of postoperative AF mainly focuses on preoperative prevention, intraoperative protection and postoperative treatment for factors prone to AF before, during and after surgery, but the postoperative treatment in various areas and hospitals is different. This article combines the latest literature published in Europace about the practice guidance of cardioversion of AF and atrial flutter, and summarizes the treatment of electrical cardioversion, in order to provide clinical guidance for electrical cardioversion of AF after cardiac surgery.
ObjectiveTo analyze the predictive value of thrombelastogram (TEG) on venous thromboembolism in elderly patients undergoing cardiac surgery.MethodsA total of 64 patients with venous thromboembolism after cardiac surgery in our hospital from March 2014 to March 2018 were selected as a pathogenesis group, including 38 males and 26 females, aged 61-73 (67.3±5.8) years. And 158 patients without venous thromboembolism who underwent cardiac surgery during the same period were selected as a control group, including 82 males and 76 females, aged 59-75 (65.9±7.1) years. Routine coagulation parameters such as plasma prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (Fib), D-dimer (D-D), platelet count (PLT) and various indicators of TEG were measured in two groups. The correlation analysis was performed on the obtained results, and the specificity and sensitivity of conventional coagulation indicators and TEG indicators for venous thromboembolism were analyzed and compared.ResultsThere were significant differences between the two groups in routine coagulation parameters and TEG (P<0.05). The area under the receiver operating characteristic (ROC) curve for each indicator was >0.5, which was of diagnostic significance. When the sensitivity>90%, the highest specificity value was also selected. The sensitivity and specificity of each indicator of TEG were greater than those of conventional coagulation indicators. The reaction time (R) was positively correlated with APTT in all indicators of TEG, and coagulation speed (K) was negatively correlated with Fib and PLT. Maximum thrombus intensity (MA) and Angle were positively correlated with Fib and PLT (all P<0.05). There was no correlation between TEG indicators and D-D.ConclusionThe TEG has higher predictive value for postoperative venous thromboembolism in elderly patients undergoing cardiac surgery than conventional coagulation tests. However, D-D level tests have unique diagnostic value in the diagnosis of venous thromboembolism.
The incidence of postoperative excessive bleeding and reexploration is relatively high, and it will bring a series of serious complications, such as an additional surgery, a longer intensive care unit stay, longer time on mechanical ventilation, an increase need of allogeneic blood product transfusions and increased mortality. However, the understanding of postoperative excessive bleeding and reexploration in China is significantly different from the international level, and the understanding of postoperative excessive bleeding and reexploration after cardiac surgery in clinical work is still not enough. This review will focus on some problems, such as related factors analysis of postoperative excessive bleeding, hemostatic process optimization and the serious complications of reexploration after cardiac surgery.
ObjectiveTo observe the short-term therapeutic outcomes of atrial septal defects (ASD) repair using on-pump beating-heart technique assisted by robotic surgery system (Da Vinci Si) or thoracoscopy.MethodsClinical data of 50 patients undergoing ASD repair at the First Affiliated Hospital of Anhui Medical University from January 2015 to December 2018 were retrospectively analyzed. According to the different surgical methods, patients were divided into a robot group and a total thoracoscopy group. In the robot group, there were 35 patients including 11 males and 24 females, at an average age of 42.1±16.8 years, and in the total thoracoscopy group there were 15 patients including 8 males and 7 females at an average age of 38.4±10.9 years. During follow-up, the left ventricular ejection fraction, left and right atrial diameter, and right ventricular end-diastolic diameter in the cardiac Doppler echocardiography were recorded. The operation time, extracorporeal circulation time, ventilation time, postoperative ICU stay, postoperative hospital stay, perioperative pleural drainage and early complications were compared between the two groups.ResultsIn the perioperative period, the robot group had less operation time (3.8±0.3 h vs. 6.1±1.4 h), extracorporeal circulation time (72.3 ± 10.4 min vs. 139.1 ± 32.8 min), ventilation time (5.5±1.2 h vs. 9.5 ± 2.1 h), postoperative hospital stay (6.7±0.5 d vs. 9.8 ± 0.6 d) and thoracic drainage (253.4±26.8 mL vs. 289.3 ± 29.5 mL) than the total thoracoscopy group (P<0.05), while the postoperative complications were not statistically significant between the two groups (P>0.05). All patients were reviewed by color Doppler ultrasound at 1 month after operation. The postoperative dilated right atrium, right ventricle and left atrium were smaller than those before surgery.ConclusionFor patients undergoing ASD repair, robot-assisted and total thoracoscopy can achieve good results, but the robot group has more advantages in terms of operation time, extracorporeal circulation time, ventilation time, postoperative hospital stay and thoracic drainage.
ObjectiveTo evaluate the feasibility, safety, and short-term effect of minimally invasive ascending aorta surgery through a right anterior thoracotomy via the second intercostal incision.MethodsThe clinical data of 13 patients who underwent minimally invasive ascending aorta surgery (including minimally invasive Bentall operation in 7 patients, minimally invasive Wheat operation in 2 patients, and minimally invasive ascending aorta replacement in 4 patients) through a right anterior thoracotomy via the second intercostal incision in our center from October, 2019 to September, 2020 were retrospectively analyzed. There were 12 males and 1 female at age of 19-69 (52.4±13.7) years.ResultsThe aortic cross-clamping time was 84.3±18.3 min. Three patients received blood transfusion, with the rate of 23.1%. The drainage volume in the first 24 hours after operation was 214.5±146.3 mL, with no redo for bleeding. The duration of mechanical ventilation was 19.0±11.3 hours and the length of intensive care unit stay was 1.8±1.3 days. The drainage tube was removed 2.5±1.0 days after operation. All the 13 patients recovered and discharged 6.4±2.0 days after operation, with no dead patients found. All patients survived with New York Heart Association (NYHA) functional classⅠandⅡduring a median follow-up of 8 months.ConclusionMinimally invasive ascending aorta surgery through a right anterior thoracotomy via the second intercostal incision may be a safe and effective method with less injury and quick recovery.