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.