<div>Early clinical outcomes of total thoracoscopic aortic valve replacement</div><div>Chao Song<sup>1,2</sup>,
Yunlong Fan<sup>1,2</sup>, Siming Zhu<sup>1,2</sup>,
Shengli Jiang<sup>2</sup>*</div><div><sup>1</sup>Medical School
of Chinese PLA, Beijing, 100853, P.R. China</div><div><sup>2</sup>Department of Cardiovascular Surgery, the First
Medical Centre of Chinese PLA General Hospital, Beijing 100853, China</div><div><sup>*</sup>Correspondence:
Dr. Shengli Jiang, Department of Cardiovascular Surgery, Chinese PLA
General Hospital, 100853, Beijing, China. E-mail:
JiangSL301hospital@163.com.</div><div>Conflicts of interest</div><div>The authors declare that there are no conflicts of interest.</div><div>This research did not receive any specific grant from funding agencies
in the public, commercial, or not-for-profit sectors.</div><div><b>Objective:</b> 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.</div><div>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.</div><div><b>Methods:</b> 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.</div><div><b>Results:</b> 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.</div><div><b>Conclusions:</b> Despite the need for improvement, total
thoracoscopic aortic valve replacement is safe, and may improve clinical
outcome.</div>