Patient selection
We retrospectively reviewed the clinical outcomes of consecutive patients who underwent minimally invasive VSD patch repair at our institution between 2012 and 2019. The data were collected in our departmental database. The selection criteria for totally thoracoscopic VSD repair at our department were as follows: (1) perimembranous, membranous or inlet VSD as diagnosed by preoperative echocardiography; (2) body weight ≥30 Kg; (3) no concomitant thoracic deformity or history of surgery of the right chest; (4) no concomitant femoral artery or aortic malformation, severe aortic atherosclerosis, or other cardiac malformations (patent ductus arteriosus, persistent left superior vena cava); and (5) no concomitant severe pulmonary arteria systolic pressure.
The outcomes of patients who underwent VSD repair by total thoracoscopic were compared with those of patients who underwent mini-sternotomy. The outcomes of interest included hospital mortality, ventilation time, intensive care unit (ICU) stay time, postoperative hospital time, rates of blood transfusion, volume of chest drainage and postoperative complications. The postoperative complications included low cardiac output syndrome, respiratory failure, stroke, myocardial infarction, reoperation for bleeding, tricuspid regurgitation, residual shunt, complete atrioventricular conduction block, and wound infections. The requirement for individual patient consent was waived in light of the retrospective nature of the database assessment.