Liu Zihou, Maimaitiaili Abulizi, Ma Xiaozhong, Dong Shuangfeng, Wei Wei, Wang Qiang, Chen Qingliang, Liu Jianshi, Guo Zhigang
Department of Cardiovascular Surgery, Clinical School of Thoracic, Tianjin Medical University, Tianjin, China.
Department of Cardiovascular Surgery, Chest Hospital, Tianjin University, Tianjin, China.
Front Cardiovasc Med. 2024 Aug 8;11:1414333. doi: 10.3389/fcvm.2024.1414333. eCollection 2024.
Minimally invasive cardiac surgery offers numerous advantages that patients and surgeons desire. This surgical platform encompasses cannulation strategies for cardiopulmonary bypass, optimal surgical access points, and high-quality visualization techniques. Traditional peripheral cannulation methods, though convenient, possess inherent limitations and carry the potential for complications such as retrograde dissection, stroke, or neurologic sequelae. Conversely, central cannulation may be ideally suited to circumvent the disadvantages above. Fully video-assisted thoracoscopy cardiac surgery represents a state-of-the-art platform, offering surgeons an unparalleled surgical view. This analysis aimed to delineate the efficacy and safety of transthoracic central cannulation strategies and the surgical platform during fully video-assisted thoracoscopy cardiac surgery.
Between October 2022 and February 2024, we identified a cohort of 85 consecutive patients with cardiopulmonary bypass undergoing fully video-assisted thoracoscopy cardiac surgery at our institutions. The patients' mean age was 41.09 ± 14.01 years, ranging from 18 to 75 years. The mean weight was 64.34 ± 10.59 kg (ranging from 49 to 103 kg). Congenital heart disease repair accounted for the highest proportion, with 43 cases (50.59%). Mitral valve surgery and left atrium Myxoma resections accounted for 29.41%. Specifically, this included 14 mitral valve repairs, five mitral valve replacements, and six left atrium myxoma resections. Aortic valve replacements constitute 20% of all cases.
A total of 85 adult patients underwent fully video-assisted thoracoscopy cardiac surgery. The average CPB time was 83.26 ± 28.26 min, while the aortic cross-clamp time averaged 51.87 ± 23.91 min. The total operation time (skin to skin) averaged 173.8 ± 37.08 min. The mean duration of mechanical ventilation was 5.58 ± 3.43 h, ICU stay was 20.04 ± 2.83 h (ranging from 15.5 to 34 h), and postoperative hospital stay was 5.55 ± 0.87 days. No patients required conversion to thoracotomy and unplanned reoperations due to various reasons. There were no in-hospital deaths, strokes, myocardial infarctions, aortic dissections, or renal failure. No patient developed wound soft tissue infection.
Fully video-assisted thoracoscopy cardiac surgery utilizing central cannulation strategies is a reliable, cost-effective platform with a low risk of complications and a potential solution for patients facing contraindications for peripheral cannulation.
微创心脏手术具有患者和外科医生所期望的众多优势。该手术平台涵盖体外循环插管策略、最佳手术入路点和高质量可视化技术。传统的外周插管方法虽然方便，但存在固有局限性，并有可能引发诸如逆行夹层、中风或神经后遗症等并发症。相反，中心插管可能非常适合规避上述缺点。全胸腔镜辅助心脏手术代表了一种先进的平台，为外科医生提供了无与伦比的手术视野。本分析旨在阐明经胸中心插管策略及手术平台在全胸腔镜辅助心脏手术中的疗效和安全性。
在2022年10月至2024年2月期间，我们确定了一组连续85例在我们机构接受全胸腔镜辅助心脏手术并进行体外循环的患者。患者的平均年龄为41.09±14.01岁，年龄范围为18至75岁。平均体重为64.34±10.59千克（范围为49至103千克）。先天性心脏病修复占比最高，有43例（50.59%）。二尖瓣手术和左心房黏液瘤切除术占29.41%。具体包括14例二尖瓣修复、5例二尖瓣置换和6例左心房黏液瘤切除术。主动脉瓣置换占所有病例的20%。
共有85例成年患者接受了全胸腔镜辅助心脏手术。平均体外循环时间为83.26±28.26分钟，而主动脉阻断时间平均为51.87±23.91分钟。总手术时间（皮肤到皮肤）平均为173.8±37.08分钟。机械通气的平均持续时间为5.58±3.43小时。重症监护病房停留时间为20.04±2.83小时（范围为15.5至34小时），术后住院时间为5.55±0.87天。没有患者因各种原因需要转为开胸手术或进行计划外再次手术。没有院内死亡、中风、心肌梗死、主动脉夹层或肾衰竭病例。没有患者发生伤口软组织感染。
采用中心插管策略的全胸腔镜辅助心脏手术是一个可靠、具有成本效益的平台，并发症风险低，对于面临外周插管禁忌证的患者是一种潜在的解决方案。
