Sabate Rotes Anna, Burkhart Harold M, Suri Rakesh M, Grogan Martha, Taggart Nathaniel W, Li Zhuo, Schaff Hartzell V, Dearani Joseph A
Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA.
Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
World J Pediatr Congenit Heart Surg. 2014 Oct;5(4):527-33. doi: 10.1177/2150135114542166.
To compare the safety and effectiveness of video-assisted thoracic surgery (VATS) versus conventional median sternotomy (open) in the repair of secundum atrial septal defect (ASD) or patent foramen ovale (PFO).
Among 415 consecutive patients undergoing open or VATS ASD/PFO closure between 1993 and October 2012, 153 patients were compared using 2:1 frequency matching (n=102 open vs 51 VATS). Matching variables include age, gender, body surface area, past medical history of neurologic events, and need of patch closure. Median age was 43 years (3-71 years), and 67% were female.
There were no early deaths in either group. There were no conversions to open sternotomy. Although mean cross-clamp time (14.5±7.6 vs 26.3±13.2 minutes, P<.001) and bypass time (31.7±13.8 vs 60.9±20.9 minutes, P<.001) were longer in the VATS group, patients who underwent VATS had shorter postoperative ventilation time (7.5±6.4 vs 4.4±2.8 hours, P=.03) with 62.7% extubated in the operating room, along with shorter intensive care unit stay (26.7±10.8 vs 19.1±9.9 hours, P<.001) and hospital stay (5.2±1.9 vs 3.5±0.9 days, P<.001). At early follow-up (mean 1.5 years, maximum 4.2 years), there was no difference in need for reintervention. Of the 27 patients who underwent VATS ASD/PFO closure for a neurologic event, none had a recurrence.
The use of VATS provides a safe, equally effective alternative to conventional sternotomy for ASD/PFO closure, using a less invasive approach.
比较电视胸腔镜手术（VATS）与传统正中开胸手术（开放手术）在继发孔房间隔缺损（ASD）或卵圆孔未闭（PFO）修补术中的安全性和有效性。
在1993年至2012年10月期间连续接受开放手术或VATS ASD/PFO封堵术的415例患者中，采用2:1频率匹配对153例患者进行比较（n = 102例开放手术 vs 51例VATS）。匹配变量包括年龄、性别、体表面积、既往神经系统事件病史以及是否需要补片修补。中位年龄为43岁（3 - 71岁），67%为女性。
两组均无早期死亡病例。无中转开胸手术情况。虽然VATS组的平均主动脉阻断时间（14.5±7.6 vs 26.3±13.2分钟，P <.001）和体外循环时间（31.7±13.8 vs 60.9±20.9分钟，P <.001）较长，但接受VATS手术的患者术后通气时间较短（7.5±6.4 vs 4.4±2.8小时，P =.03），62.7%在手术室拔管，重症监护病房住院时间较短（26.7±10.8 vs 19.1±9.9小时，P <.001），住院时间也较短（5.2±1.9 vs 3.5±0.9天，P <.001）。在早期随访（平均1.5年，最长4.2年）时，再次干预的需求无差异。在因神经系统事件接受VATS ASD/PFO封堵术的27例患者中，无一例复发。
对于ASD/PFO封堵术，VATS的应用为传统开胸手术提供了一种安全、同样有效的替代方法，且采用的是侵入性较小的手术方式。
