title: Totally thoracoscopic repair of ventricular septal defect: a short-term clinical observation on safety and feasibility.
abstract: OBJECTIVE
  We sought to investigate the feasibility and safety of totally thoracoscopic repair of a ventricular septal defect.
  
  
  METHODS
  Totally thoracoscopic repair of a perimembranous ventricular septal defect was performed in 36 patients (16 male patients; age, 5-19 years; average age, 10.2 ± 4.5 years). Patients with a pulmonary arterial systolic pressure of 60 mm Hg or greater or with supracristal or muscular ventricular septal defects were excluded. An additional 16 patients undergoing open-chest ventricular septal defect repair were selected as a control group. Through 3 port incisions in the right chest, pericardiotomy, bicaval occlusion, atriotomy, and ventricular septal defect repair were performed by a surgeon by means of thoracoscopy.
  
  
  RESULTS
  The cardiopulmonary bypass and aortic crossclamp times were 66.2 ± 21.3 and 36.4 ± 8.2 minutes, respectively. The length of stay in the intensive care unit was 20.0 ± 4.1 hours. There were no mortalities and no major complications. Transesophageal echocardiographic analysis 5.2 ± 3.6 months after the operation showed complete closure of the defect without residual shunt. The intensive care unit (17 ± 2 vs 25 ± 5 hours, P = .01) or postoperative hospital (4.2 ± 1.1 vs 6.7 ± 2.1 days, P = .03) stays in the thoracoscopic group were shorter than in the control group. The percentage of patients who required postoperative opioid analgesics in the thoracoscopic group was lower than in the control group (37.5% vs 87.5%, P = .001).
  
  
  CONCLUSIONS
  Totally thoracoscopic repair of a perimembranous ventricular septal defect is feasible and safe for older children. This technique is associated with a reduced intensive care and hospital stay in comparison with conventional ventricular septal defect repair.
authors: Department of Cardiac Surgery, Liaocheng People's Hospital and Liaocheng Clinical School of Taishan Medical University, Liaocheng, China.
authors: Zeng-Shan
authors: ZS
authors: Ma
authors: Ming-Feng
authors: MF
authors: Dong
authors: Qiu-Yang
authors: QY
authors: Yin
authors: Zhi-Yu
authors: ZY
authors: Feng
authors: Le-Xin
authors: LX
authors: Wang
mesh_terms: D000293:Adolescent; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D002315:Cardiopulmonary Bypass; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D002681:China; D003422:Critical Care; D017548:Echocardiography, Transesophageal; D005240:Feasibility Studies; D005260:Female; D006345:Heart Septal Defects, Ventricular / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D009294:Narcotics / Q000627:therapeutic use; D010149:Postoperative Pain / Q000188:drug therapy / Q000209:etiology; D010492:Pericardiectomy; D018570:Risk Assessment; D012307:Risk Factors; D013906:Thoracoscopy / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D009294:Narcotics