Gilbert Sebastien, Kilic Arman, Yaeger Karl, Toyoda Yoshiya, Bermudez Christian, Siegenthaler Michael P, Kormos Robert L
Division of Thoracic Surgery, The Ottawa Hospital, General Campus, Ottawa, ONT, Canada.
Interact Cardiovasc Thorac Surg. 2012 Jan;14(1):44-7. doi: 10.1093/icvts/ivr020. Epub 2011 Nov 18.
The aim of this study was to compare our experience between open and video-assisted thoracic surgery (VATS) approaches to the management of thoracic effusions in ventricular assist device (VAD) patients. This was a retrospective review of a prospectively collected database of VAD patients at a single institution. Patients who were operated on for pericardial and/or pleural effusions were included. Primary outcomes included operative mortality and morbidity as well as effusion recurrence. From 1993 to 2009, 360 adult patients underwent VAD placement. Twenty-three patients (11.9%) required operative management of pleural (n = 24), pericardial (n = 13) or both pleural and pericardial (n = 6) effusions [open = 20 (47%); VATS = 23 (53%)]. Drainage with decortication was performed in five patients, with the remaining undergoing drainage alone. Open and VATS patients were similar in age, gender and indication for VAD support. Conversion from VATS to open was necessary in four patients (17%). There was no operative mortality and no difference in perioperative complications between approaches. The open and VATS approaches had similar rates of pleural (open = 63%; VATS = 41%; P = 0.42) and pericardial (open = 31%; VATS = 17%; P = 1) effusion recurrences. In spite of apparent challenges, the VATS approach may be as safe and effective as open surgery for the management of pleural and pericardial effusions in VAD patients in centres with significant minimally invasive thoracic experience.
本研究的目的是比较我们在采用开放手术和电视辅助胸腔镜手术（VATS）治疗心室辅助装置（VAD）患者胸腔积液方面的经验。这是一项对单机构前瞻性收集的VAD患者数据库的回顾性研究。纳入了因心包积液和/或胸腔积液而接受手术的患者。主要结局包括手术死亡率和发病率以及积液复发情况。1993年至2009年，360例成年患者接受了VAD植入。23例患者（11.9%）需要对胸腔（n = 24）、心包（n = 13）或胸腔和心包积液（n = 6）进行手术治疗[开放手术 = 20例（47%）；VATS = 23例（53%）]。5例患者进行了胸膜剥脱引流，其余患者仅进行了引流。开放手术组和VATS组患者在年龄、性别和VAD支持指征方面相似。4例患者（17%）需要从VATS转为开放手术。两种手术方式均无手术死亡，围手术期并发症也无差异。开放手术组和VATS组的胸腔积液复发率相似（开放手术组 = 63%；VATS组 = 41%；P = 0.42），心包积液复发率也相似（开放手术组 = 31%；VATS组 = 17%；P = 1）。尽管存在明显挑战，但在有丰富微创胸外科经验的中心，VATS治疗VAD患者胸腔和心包积液可能与开放手术一样安全有效。
