[Clinical experience of 2 543 cases of congenital heart diseases undergoing totally thoracoscopic cardiac surgery in a single center].

OBJECTIVE: To summarize the experience of totally thoracoscopic cardiac surgical (TTCS) at congenital heart diseases (CHD) treatment.

METHODS: From April 2000 to March 2016, 2 543 patients with CHD underwent TTCS in Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, including 957 male and 1 586 female patients. The age ranged from 0.5 to 66.0 years with a mean age of (21±18) years. The body weight ranged from 6 to 118 kg with a mean of (49±30) kg. Patients were diagnosed with echocardiography or transesophagel echocardiography as complex or complicated CHD which was unsuitable for percutaneous procedure. Surgical procedures were performed through 3 holes inserted at the right chest wall, and catheters were placed in the right femoral artery and vein to set up cardiopulmonary bypass.The ascending aorta was cross-clamped with long tailor-made forceps and the myocardium was protected by coronary perfusion with cold crystalloid(blood)cardioplegia. There were 787 cases (from January 2013 to December 2015) were selected to compare with 710 cases underwent conventional thoracotomy over the same period. Statistical analysis was performed by t test, t' test, rank-sum test, χ(2) test and Fisher exact test, respectively.

RESULTS: The total death rate and the major complication rate of the operation were 0.35% (9/2 543) and 2.28% (58/2 543), respectively. All patients were followed up 1 to 190 months and the average follow-up time was (75±34) months. No residual shunt or obvious mitral/tricuspid regurgitation was observed, and the patients gained better cardiac function as level Ⅰ to Ⅱ (New York Heart Association classification). There was no significant difference in aorta clamp time, ICU stay, hospital cost, and surgical fatality rate between 787 patients underwent TTCS and 710 conventional thoracotomy. The cardiopulmonary bypass time ((31±20) minuets vs. (40±17) minuets, t'=9.407, P=0.001), operation time ((91±27) minuets vs. ( 102±64) minuets, t'=4.251, P=0.000), hospital stay ((5.3±2.2) d vs. (13.0±4.0) d, t'=45.463, P=0.000), postoperative drainage (M(QR): 33(17) ml vs. 121(53) ml, T=2.632, P=0.000) and major complications (7/787 vs. 23/710, χ(2)=10.49, P=0.001) were significantly reduced and no sternal deformation occurrence (0 vs. 192/710, χ(2)=244.10, P=0.000) in TTCS group. While the cost was higher in TTCS group ((24 000±400) yuan vs. (20 000±400) yuan, t=19.320, P=0.000).

CONCLUSION: TTCS is feasible, safe, and minimal invasive for patients with CHD, resulting in quick recovery and good median-long term outcomes.