Application and advantages of complete thoracoscopy in the intracardiac correction of partial atrioventricular septal defect

Abstract

Objectives The clinical data of partial atrioventricular septal defect (PAVSD) treated by total thoracoscopy and median thoracotomy were retrospectively analyzed. The application and advantages of total thoracoscopy in PAVSD were discussed. Methods A retrospective study was conducted on 226 patients with partial atrioventricular septal defect from Jan. 2010 to Dec. 2017 in the First Affiliated Hospital of Air Force Military Medical University. They were divided into complete thoracoscopy group and median thoracotomy group. The indexes of surgical trauma, clinical indexes of postoperative recovery and long-term follow-up were collected and compared between the two groups. Result 226 cases were operated successfully.The complete thoracoscopy group was less than the median thoracotomy group in terms of blood transfusion[(90.6±52.3)ml vs (285±103.5)ml]、intraoperative bleeding [(109.2±25.4)ml vs (235.3±101.3)ml] and postoperative drainage (115.1±63.2)ml vs (225.2±97.3)ml], and the difference was statistically significant(P<0.05). The time of closing the chest[(12.0±3.6)min vs (44.2±15.0)min], operation time [(155.3±28.7)min vs (183.6±37.6)min], pain score[(3.4±0.7)vs(6.9±1.5)], postoperative hospital stay[(6.2±2.1)d vs (10.7±2.9)d] and ICU recovery time[(42.1±11.9)h vs (60.3±12.4)h] were shorter than those of the median thoracotomy group, and the difference was statistically significant.There was no significant difference in the time of aortic occlusion between the two groups (P<0.05). The incidence of complications of poor wound healing in the complete thoracoscopy group was significantly lower than that in the median thoracotomy group (P<0.05). The incidence of atelectasis and pneumothorax in the complete thoracoscopy group was slightly higher than that in the median thoracotomy group, the difference was not statistically significant.The incidence of pericardial tamponade and high atrioventricular block in the complete thoracoscopy group was lower than that in the median thoracotomy group.One year after operation, there was no significant difference in EF value between the two groups. Conclusions Complete thoracoscopic surgery for PAVSD is a safe, effective and minimally invasive method with less trauma, fewer complications, beautiful incision and short recovery period. It is worth popularizing widely. Key words: Complete thorascopic cardiac surgery; Median sternotomy cardiac surgery; Partial atrioventricular septal defect