ABSTRACT
@#Objective To monitor surgical quality and analyze learning curve of minimally invasive totally thoracoscopic cardiac surgery. Methods We retrospectively analyzed the clinical data of 150 consecutive patients who underwent minimally invasive totally thoracoscopic cardiac surgery in the Guangdong General Hospital between January 2013 and December 2015. There were 60 males and 90 females at age of 43.1 years. There were 60 patients with atrial or ventricular septal defect repair, 12 patients with cardiac tumor resection, 53 patients with mitral valve replacement and 25 patients with mitral valve repair. According to the surgical sequence, all the patients were divided into 3 groups including a group A, group B, and group C with 50 patients in each group (every 10 patients as a sequence, every 5 sequence as a group). Surgical outcomes were compared among the 3 groups, and surgical quality was analyzed with descriptive statistics. Results Surgical failure rate was 6.7% (10/150). There was no in-hospital mortality. Aortic cross-clamp time, cardiopulmonary bypass time and duration of mechanical ventilation, duration of ICU stay, duration of hospital stays of the group C were significantly shorter than those of the group A and group B. Analysis showed a significant learning curve effect in totally thoracoscopic cardiac surgery. When surgical cases reached about 100 cases, cardiopulmonary bypass and aortic cross-clamp time was shorter than the average value stably. Conclusion Totally thoracoscopic cardiac surgery is safe and reliable. For the beginners, it needs about 100 patients of surgery to master the totally thoracoscopic cardiac surgery.
ABSTRACT
Objective To study the protective effect of Shenmai injection on myocardial ischemia reperfusion injury in patients underwent thoracoscopic cardiac surgery during cardiopulmonary bypass (CPB). Methods 18 patients with congenital heart disease with CPB thoracoscopic cardiac surgery were randomly divided into two groups (9 cases in each group): controlled group and experimental group. The controlled group did not give any intervened drugs, and the experimental group gave the injection of Shenmai that were added into heart cold cardioplegia (2 ml/kg). The levels of the following indexes in the serum were respectively measured just after the time of induction of anesthesia (T1) and heart resuscitation (T2): Troponin T (cTnT), Creatine kinase isoenzyme (CK-MB) quality, myoglobin (Mb). And at the same time, the left ventricular ejection fraction (EF) was measured. Results The concentrations of cTnT, CK-MB and mb in the serum of both groups just after the time of heart resuscitation (T2) were significantly increased more than just after the time of induction of anesthesia (T1) (P < 0.05). But the concentrations of cTnT, CK-MB and Mb in the experimental group were significantly lower than that in the controlled group just after the time of cardiac resuscitation. And EF was significantly higher than the controlled group (P < 0.05). Conclusion Shenmai injection can protect the myocardium from ischemia-reperfusion injury in patients underwent thoracoscopic cardiac surgery during cardiopulmonary bypass (CPB).