Results
During the study period, 67 patients underwent minimally invasive VSD
repair at our institution, of whom 36 (females 27, males 9; mean age,
29.08 ± 9.52 years) underwent total thoracoscopic VSD repair and 31
(females 12, males 19; mean age, 28.39 ± 8.67 years) underwent
mini-sternotomy VSD repair. There was no significant difference in basic
preoperative data between the groups, except for the higher proportion
of women in the total thoracoscope group (75% vs 38.7%;p =0.003). Preoperative echocardiography showed 33 perimembranous
VSDs and three inlet VSDs in total thoracoscopic group, while four
perimembranous VSDs and 27 doubly committed and juxta-arterial VSD. See
Table 1 for details.
All patients underwent surgery on an elective basis. The mean CPB and
ACC time in the total thoracoscopy group was significantly longer than
that of the mini-sternotomy group (CPB time: 111.78 ± 23.16 min vs 77.58
± 37.90 min, respectively, p < 0.001; ACC time: 111.78 ± 23.16
min vs 77.58 ± 37.90 min, respectively, p < 0.001). Five
patients in the total thoracoscopy group underwent tricuspid
valvuloplasty with Edward ring followed by VSD repair. They suffered
from tricuspid regurgitation due to annular or right ventricular
dilatation as a result of left-to-right shunt. In 24 patients, for whom
exposure of VSD was difficult due to septal leaflets attached to the rim
of the VSD to form an aneurysm or abnormal chordal attached to the
septum, underwent tricuspid valve detachment in the total thoracoscopy
group. They were all free from atrioventricular conduction block and
tricuspid regurgitation during the follow-up period. See Table 2 for the
relevant data.
There were no inpatient deaths in either group (Table 3); however, one
patient in the mini-sternotomy group underwent tracheotomy due to
pulmonary infection and could not be taken off the ventilator. Finally,
the patient was discharged from the hospital and transferred to a local
hospital for further treatment. The patient did not die during
follow-up. Only one patient in the TT group was found to have residual
shunt immediately after coming off bypass, measured at 1.5 mm using
transesophageal echocardiography. It disappeared spontaneously by the
time of discharge. No patients underwent reoperation for bleeding in the
TT group; however, one patient did so in the mini-sternotomy group. This
patient had bleeding because of the sternotomy. Tracheal intubation time
(6.42 ± 3.85 hours vs 28.55 ± 123.18 hours, p = 0.325), ICU time (20.47
± 9.52 hours vs 49.65 ± 163.72 hours, p = 0.330) and postoperative
hospital stay time (5.11 ± 2.48 days vs 5.90 ± 6.27 days, p = 0.488)
tended to be shorter in the thoracoscopy group than in the
mini-sternotomy group, suggesting faster recovery in the thoracoscopy
group. In addition, the chest drainage was less in the thoracoscopy
group than in the mini-sternotomy group (139.86 ± 111.71 ml vs 196.13 ±
147.34 ml, p = 0.081). One patient in the mini-sternotomy group had
wound infection, which recovered after wound debridement and vacuum
sealing drainage. There were no low cardiac output syndromes, strokes,
complete atrioventricular conduction blocks, myocardial infarction, or
tricuspid regurgitation in either group. Follow-up duration ranged from
12 months to 96 months. No patient died, and echocardiography showed no
residual shunts or tricuspid regurgitation at follow-up.