Early clinical outcomes of total thoracoscopic aortic valve replacement
Chao Song1,2, Yunlong Fan1,2, Siming Zhu1,2, Shengli Jiang2*
1Medical School of Chinese PLA, Beijing, 100853, P.R. China
2Department of Cardiovascular Surgery, the First Medical Centre of Chinese PLA General Hospital, Beijing 100853, China
*Correspondence: Dr. Shengli Jiang, Department of Cardiovascular Surgery, Chinese PLA General Hospital, 100853, Beijing, China. E-mail: JiangSL301hospital@163.com.
Conflicts of interest
The authors declare that there are no conflicts of interest.
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Objective: To evaluate the safety and reliability of total thoracoscopic aortic valve replacement with a controlled study and to analyze the current challenges that may need to be addressed.
Background: With the promotion of minimally invasive concepts and advances in total thoracoscopic valve surgery, total thoracoscopic aortic valve surgery has become a new option for patients with aortic valve lesions. However, due to its anatomical characteristics, poor surgical field exposure and limited operating space, only a few centers have performed further studies on this procedure.
Methods: A total of 230 patients underwent AVR were divided into the total thoracoscopic AVR group (n=18), the upper mini-sternotomy AVR group (n=43), and the conventional AVR group (n=169) according to the surgical access. Cardiopulmonary bypass (CPB) time, aortic clamping (AC) time, postoperative chest drainage in the first 24 h (ML), ICU and Hospital stay, Mechanical ventilation length and VAS pain score were used as evaluation variables to evaluate the safety and reliability of total thoracoscopic aortic valve replacement compared to the upper mini-sternotomy AVR group and the conventional AVR group.
Results: All patients successfully underwent elective surgery, with no intraoperative conversion or death occurring. Patients in the total thoracoscopy group had significantly prolonged CPB and aortic clamping (AC) times compared to the other two groups. The average Postoperative chest drainage in the first 24 h of the total thoracoscopic group was significantly less than the other two groups. The mean VAS pain score in the total thoracoscopic group was significantly less than the other two groups. In addition, the total thoracoscopic group had a significantly decreased ICU stay as well as the total hospital stay. Although the length of mechanical ventilation between groups did not show statistically significant differences, mechanical ventilation in the total thoracoscopy group had a smaller relative number.
Conclusions: Despite the need for improvement, total thoracoscopic aortic valve replacement is safe, and may improve clinical outcome.