Department of Cardiac Surgery, Liaocheng People's Hospital and Liaocheng Clinical School of Taishan Medical University, Liaocheng, China.
J Thorac Cardiovasc Surg. 2011 Oct;142(4):850-4. doi: 10.1016/j.jtcvs.2011.03.001. Epub 2011 Mar 31.
We sought to investigate the feasibility and safety of totally thoracoscopic repair of a ventricular septal defect.
Totally thoracoscopic repair of a perimembranous ventricular septal defect was performed in 36 patients (16 male patients; age, 5-19 years; average age, 10.2 ± 4.5 years). Patients with a pulmonary arterial systolic pressure of 60 mm Hg or greater or with supracristal or muscular ventricular septal defects were excluded. An additional 16 patients undergoing open-chest ventricular septal defect repair were selected as a control group. Through 3 port incisions in the right chest, pericardiotomy, bicaval occlusion, atriotomy, and ventricular septal defect repair were performed by a surgeon by means of thoracoscopy.
The cardiopulmonary bypass and aortic crossclamp times were 66.2 ± 21.3 and 36.4 ± 8.2 minutes, respectively. The length of stay in the intensive care unit was 20.0 ± 4.1 hours. There were no mortalities and no major complications. Transesophageal echocardiographic analysis 5.2 ± 3.6 months after the operation showed complete closure of the defect without residual shunt. The intensive care unit (17 ± 2 vs 25 ± 5 hours, P = .01) or postoperative hospital (4.2 ± 1.1 vs 6.7 ± 2.1 days, P = .03) stays in the thoracoscopic group were shorter than in the control group. The percentage of patients who required postoperative opioid analgesics in the thoracoscopic group was lower than in the control group (37.5% vs 87.5%, P = .001).
Totally thoracoscopic repair of a perimembranous ventricular septal defect is feasible and safe for older children. This technique is associated with a reduced intensive care and hospital stay in comparison with conventional ventricular septal defect repair.
我们旨在探究全胸腔镜下心室间隔缺损修补术的可行性和安全性。
36 例膜周部室间隔缺损患者（男 16 例，年龄 5~19 岁，平均 10.2±4.5 岁）接受了全胸腔镜下心室间隔缺损修补术。排除肺动脉收缩压≥60mmHg 或嵴上型或肌部室间隔缺损患者。选择同期 16 例行开胸室间隔缺损修补术的患者作为对照组。通过右胸 3 个切口、心包切开、双腔静脉阻断、心房切开和室间隔缺损修补术，由外科医生通过胸腔镜完成。
体外循环和主动脉阻断时间分别为 66.2±21.3 和 36.4±8.2 分钟。重症监护病房的住院时间为 20.0±4.1 小时。无死亡和重大并发症。术后 5.2±3.6 个月行经食管超声心动图分析显示，缺损完全闭合，无残余分流。胸腔镜组的重症监护病房（17±2 小时比 25±5 小时，P=0.01）或术后住院（4.2±1.1 天比 6.7±2.1 天，P=0.03）时间均短于对照组。胸腔镜组需要术后阿片类药物镇痛的患者比例低于对照组（37.5%比 87.5%，P=0.001）。
对于大龄儿童，全胸腔镜下心室间隔缺损修补术是可行和安全的。与传统室间隔缺损修补术相比，该技术可减少重症监护病房和住院时间。
