Operation and postoperative data
Clinical baseline data of the patients were present in Table 1. No statistically significant differences were observed in the preoperative baseline data, baseline data for the three groups of patients were statistically comparable.
All patients completed the surgery successfully, with no intraoperative death or conversion of surgical procedures. Operation and postoperative characteristics are summarized in Table 2. 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 172.22±56.35, which was significantly less than the other two groups. The mean VAS pain score in the total thoracoscopic group was 2.33±0.49, significantly less than the other two groups which were 2.58±0.54 and 3.28±0.52 respectively. In addition, the total thoracoscopic group had a significantly decreased ICU stay as well as the total hospital stay, 1.46±0.27 and 11.78±1.26, respectively. 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.
As shown in the Table3, none of the patients experienced hospital mortality, serious complications, respiratory failure, secondary intubation, pleural effusion, pneumothorax, cerebral hemorrhage, pulmonary Infection, and sternal dehiscence. Intra-aortic balloon pump (IABP) implantation was performed in two of the patients for transient decreased cardiac output, and the IABP was successfully removed. Delayed extubation (longer than 24h) was observed in two patients in the conventional AVR group due to hypoxemia. Two patient underwent dialysis for renal insufficiency, and this patient had a preoperative history of renal insufficiency. Poor healing of incision was observed in two patients in the conventional AVR group, one with a history of diabetes mellitus and unstable blood glucose levels and the other with a local infection due to sweating. And the intraoperative hypoperfusion may have exacerbated the renal impairment, one patient experienced brain infarction without disability. In addition, one perivalvular leak was observed in one patient in the total thoracoscopy group during the 3-month follow-up without cardiac insufficiency as well as hemolytic manifestations and is continuing at follow-up.