OBJECTIVES To compare the safety and efficacy of del-Nido cardioplegia (DNC) with traditional 4:1 cold blood cardioplegia (CBC) in coronary artery bypass grafting and/or valve surgeries in elderly patients. METHODS The present study is a retrospective case-series study that included 302 consecutive patients aged 70 years and over who underwent on-pump valve surgery and/or CABG. DNC was administered to 90 patients and CBC to 212 patients. After propensity-score matching, 89 pairs were compared. The safety and efficacy were analysed between the two groups. RESULTS Compared with the CBC group (2185.8±582.9ml, P<0.001), the volume of infused cardioplegia was less in the DNC group (1423.6±259.5ml). The DNC group had a lower incidence of postoperative intra-aortic balloon pump (IABP) implantation (1.1% vs 9.0%, RR=0.791, P=0.034) and higher left ventricular ejection fraction (LVEF) at discharge (58.5±9.1% vs 55.7±8.6%, P=0.007). The estimated glomerular filtration rate (eGFR) in the DNC group was higher when the patient was transferred to the intensive care unit (78.2±25.1 ml/min/1.73m 2 vs 69.7±20.2 ml/min/1.73m 2, P=0.021), but no significant differences were identified after 24 hours. The serum lactate values of the DNC group were significantly lower than those of the CBC group (0hrs: 2.8±1.5 vs 3.6±2.0, P=0.001; 3hrs: 3.6±2.7 vs 4.9±2.6, P<0.001; 6hrs: 4.0±3.0 vs 6.1±3.3, P<0.001; 9hrs: 4.4±3.3 vs 5.9±3.6, P=0.004). There were no differences between the two groups in respect of lactate levels at 12 hours and thereafter. Postoperative creatinine kinase-MB concentrations were similar between the two groups. CONCLUSIONS Del-Nido cardioplegia is safe and effective in elderly patients undergoing CABG and/or valve surgery.

Objectives: This study aimed to compare early and long-term outcomes of redo isolated tricuspid surgery (RITS) after left-sided valve surgery (LSVS). Methods: We retrospectively reviewed 173 patients underwent RITS for severe tricuspid regurgitation after previous LSVS from January 1999 to December 2019. Patients were divided into two groups: RITS by median sternotomy (m-RITS, n = 78) and by totally endoscopic approach (e-RITS, n = 95). Perioperative outcomes and follow-up results were analyzed. Results: There were 19 (11%) in-hospital deaths (14.1% in m-RITS and 8.4% in e-RITS, p = 0.234) that decreased from 16.7% (1999–2014) to 6.9% (2015–2019) (p = 0.044). Tricuspid valve replacement [odds ratio (OR) = 6.778, 95% confidence interval (CI): 1.370–33.549, p = 0.019] and NYHA function class IV (OR = 8.525, 95% CI: 2.153–33.760, p = 0.002) were independent risk factors of in-hospital mortality. The overall 1-, 5-year, 10-year, and 15-year survival rates were 97.2% (95% CI: 94.5–99.9%),80.3% (95% CI: 71.7–88.9%), 59.2% (95% CI: 43.5–75.5%) and 49.3% (95% CI: 27.2–71.4%), respectively. Conclusion: Patients undergoing redo isolated tricuspid valve surgery carry a high risk of early mortality. Satisfactory results are achievable with endoscopic tricuspid valve surgery and repair results in lower surgical mortality than replacement with acceptable residual tricuspid regurgitation.

Objectives: To explore the safety and efficacy of total thoracoscopic repair of ventricular septal defects (VSD). We compared clinical outcomes of VSD via a total thoracoscopic approach with those of mini-sternotomy. Methods: We retrospectively reviewed clinical data from patients with VSD from 2012 to January 2019. According to the surgical pattern, they were divided into two groups: the total thoracoscopic surgery group (36 patients, 27 females, aged 29.08 ± 9.52 years), and a mini-sternotomy group (31 patients, 12 females, aged 28.39 ± 8.67 years). Results: There were no deaths in either group. In the thoracoscopic group, cardiopulmonary bypass (CPB) time and aortic cross-clamping (ACC) time were significantly longer than those of the mini-sternotomy group (CPB time: 111.78 ± 23.16 min vs 77.58 ± 37.90 min, respectively, p < 0.001; ACC time: 111.78 ± 23.16 min vs 77.58 ± 37.90 min, respectively, p < 0.001). Tracheal intubation time (6.42 ± 3.85 hours vs 28.55 ± 123.18 hours, p = 0.325), intensive care unit (ICU) stay time (20.47 ± 9.52 hours vs 49.65 ± 163.72 hours, p = 0.330), postoperative hospital stay time (5.11 ± 2.48 days vs 5.90 ± 6.27 days, p = 0.488) and chest drainage (139.86 ± 111.71 ml vs 196.13 ± 147.34 ml, p = 0.081) tended to be lower in the thoracoscopy group, although there was no significant difference. No residual shunt or tricuspid regurgitation was found at follow-up. Conclusions: Total thoracoscopic repair is safe and effective in patients with VSD, with or without tricuspid regurgitation.