title: Totally thoracoscopic repair of atrial septal defect reduces systemic inflammatory reaction and myocardial damage in initial patients.
abstract: BACKGROUND
  To compare the effect of totally thoracoscopic with conventional, open repair of atrial septal defect.
  
  
  METHODS
  Forty atrial septal defect cases were divided into two groups by surgical approach: totally thoracoscopic approach (group A, n = 20) and conventional open approach (group B, n = 20). In group A, surgical procedures were performed through three portal incisions in the right lateral chest wall under thoracoscopic vision without the aid of a computerized robotic surgical system. Notably, all operations were completed by one surgeon who had just begun using this technique. In group B, the atrial septal defects were repaired in conventional open fashion. Clinical outcomes and serum levels of tumor necrosis factor α (TNF-α), interleukin-6 (IL-6), interleukin-10 (IL-10), intercellular adhesion molecule 1 (ICAM-1), and creatine kinase isoenzyme-myocardial band (CK-MB) for the two groups were evaluated and compared.
  
  
  RESULTS
  All operations were performed successfully without serious complications. Durations of cardiopulmonary bypass (CPB), CPB setup, aortic cross-clamping, and operative procedure were significantly longer in group A than in group B (P < 0.05). The recovery times for body temperature and laboratory values of leukocytes were significantly shorter for group A than for group B (P < 0.05). There were no differences in durations of postoperative assisted ventilation or intensive care unit and hospital stays, volumes of blood transfused intraoperatively or thoracic drainage, or medical costs between the two groups. Serum levels of inflammatory factors (TNF-α, IL-6, IL-10, and ICAM-1) and CK-MB increased significantly in both groups after surgery. However, 6 h and 12 h after surgery, levels of these inflammatory factors and CK-MB were significantly lower in group A than in group B (P < 0.05).
  
  
  CONCLUSIONS
  Thoracoscopic cardiac surgery is technically feasible and safe, with less trauma and quicker recovery even when done by a surgeon newly introduced to the technique.
authors.forename: Xiang
authors.initials: X
authors.lastname: Liu
authors.affiliation: Department of Cardiothoracic Surgery, First Affiliated Hospital of Nanjing Medical University, Nanjing, China. wuyanhu@njmu.edu.cn.
authors.forename: Yanhu
authors.initials: Y
authors.lastname: Wu
authors.forename: Jinfu
authors.initials: J
authors.lastname: Zhu
authors.forename: Xiaoxia
authors.initials: X
authors.lastname: Lv
authors.forename: Yihu
authors.initials: Y
authors.lastname: Tang
authors.forename: Jie
authors.initials: J
authors.lastname: Sun
authors.forename: Shijiang
authors.initials: S
authors.lastname: Zhang
mesh_terms: D000328:Adult; D052279:Creatine Kinase, MB Form / Q000097:blood; D016207:Cytokines / Q000097:blood; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000601:surgery*; D006801:Humans; D007249:Inflammation / Q000209:etiology / Q000378:metabolism; D008297:Male; D009206:Myocardium / Q000201:enzymology; D013906:Thoracoscopy / Q000379:methods*; D013997:Time Factors; D055815:Young Adult
chemical_list: D016207:Cytokines; D052279:Creatine Kinase, MB Form