Early clinical outcomes of total thoracoscopic aortic valve replacement

Abstract

Background: With the promotion of minimally invasive concepts and advances in total thoracoscopic valve surgery, total thoracoscopic aortic valve surgery has become a new option for patients with aortic valve lesions. However, due to its anatomical characteristics, poor surgical field exposure and limited operating space, only a few centers have performed further studies on this procedure. Methods: We evaluate the safety and advantages of total thoracoscopic aortic valve replacement compared to the upper mini-sternotomy AVR group and the conventional AVR group with important perioperative data as well as early postoperative outcomes. Results: All patients successfully underwent elective surgery, with no intraoperative conversion or death occurring. Patients in the total thoracoscopy group had significantly prolonged CPB and aortic clamping (AC) times compared to the other two groups. The average Postoperative chest drainage in the first 24 h of the total thoracoscopic group was significantly less than the other two groups. The mean VAS pain score in the total thoracoscopic group was significantly less than the other two groups. In addition, the total thoracoscopic group had a significantly decreased ICU stay as well as the total hospital stay. Although the length of mechanical ventilation between groups did not show statistically significant differences, mechanical ventilation in the total thoracoscopy group had a smaller relative number. Conclusions: Despite the need for improvement, total thoracoscopic aortic valve replacement is safe, and may improve clinical outcome

Comparison of post-operative pain and quality of life between total thoracoscopic surgery and conventional full-sternotomy for aortic valve replacement

“…[10] TTS also has some drawbacks and limitations. First, TTS requires a longer cardiopulmonary bypass time and aortic cross-clamp time than CFS, [11] which may increase the risk of ischemia-reperfusion injury and neurological complications. [12] Second, TTS requires specialized instruments and skills, as well as a steep learning curve for surgeons.…”

“…[13] Third, complex aortic valve conditions, such as severe calci cation of the aortic annulus or small aortic annulus diameter that necessitates annulus enlargement, may pose challenges for thoracoscopic AVR. [11] Therefore, careful patient selection and surgical experience are essential for successful TTS. [14][15] In this study, we performed two-port thoracoscopic AVR for patients with aortic valve disease who met the inclusion and exclusion criteria.…”

“…This was consistent with previous studies that reported longer cardiopulmonary bypass time and aortic cross-clamp time for thoracoscopic AVR compared to CFS. [11][16] [17] TTS requires longer cardiopulmonary bypass and aortic cross-clamp times because of technical challenges. These include limited exposure, restricted mobility, lack of tactile feedback, and need for precise coordination.…”