title: Totally thoracoscopic versus open surgery for closure of atrial septal defect: propensity-score matched comparison.
abstract: The purpose of this study is to compare early clinical outcomes of surgical repair for isolated atrial septal defect (ASD) with a totally thoracoscopic approach without robotic assistance versus a conventional open procedure.Between September 2010 and June 2012, 254 consecutive patients with isolated ASD underwent totally thoracoscopic surgery without robotic assistance in seven institutions participating in the nationwide multi-centered registry in China. During the same period, these patients were matched using propensity score methodology with 254 patients who had accepted conventional open surgery through a median sternotomy. The early in-hospital results between the two groups were analyzed and compared.The patient age was 26.8 ± 14.0 years and weight was 52.9 ± 16.9 kg in the totally thoracoscopic group. The totally thoracoscopic surgery required longer aortic clamp time (32.1 ± 17.3 minutes versus 28.3 ± 16.7 minutes, P = .01); shorter length of stay in the intensive care unit (25.3 ± 12.2 hours versus 34.8 ± 24.4 hours, P = .001); shorter length of stay in hospital (6.5 ± 6.3 days versus 7.9 ± 6.4 days, P = .008); and shorter mechanical ventilation time (8.3 ± 5.0 hours versus 11.4 ± 14.8 hours, P = .04). The cardiopulmonary bypass (CPB) time (62.7 ± 29.3 minutes versus 61.5 ± 28.0 minutes, P = .64) showed no significant difference between the two groups. The totally thoracoscopic group had significantly less postoperative chest tube drainage (322.1 ± 213.7 mL versus 462.8 ± 398.4 mL, P = .001). The intraoperative (35.4% versus 38.6%, P = .46) and postoperative blood products usage (20.9% versus 21.3%, P = .91) showed no significant difference between the two groups.There also was no significant difference in mortality and major in-hospital complications between the two groups. The early outcomes for treatment of isolated ASD were similar between the totally thoracoscopic group conventional open operation performed through median sternotomy, despite a longer aortic clamp time in the totally thoracoscopic group.
authors.affiliation: Department of Cardiac Surgery, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijin, 100037, People's Republic of China.
authors.forename: Zheng
authors.initials: Z
authors.lastname: Zhe
authors.affiliation: Department of Cardiac Surgery, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijin, 100037, People's Republic of China.
authors.forename: Hua
authors.initials: H
authors.lastname: Kun
authors.affiliation: Institute of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China.
authors.forename: Xu
authors.initials: X
authors.lastname: Xuezeng
authors.affiliation: Department of Cardiovascular Surgery, Shanghai Yodak Cardiothoracic Hospital, Shanghai, China.
authors.forename: Chen
authors.initials: C
authors.lastname: Yunge
authors.affiliation: Department of Cardiac Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China.
authors.forename: Ma
authors.initials: M
authors.lastname: Zengshan
authors.affiliation: Department of Cardiovascular Surgery, Guangdong Provincial Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
authors.forename: Guo
authors.initials: G
authors.lastname: Huiming
authors.affiliation: Department of Cardiothoracic Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
authors.forename: Liu
authors.initials: L
authors.lastname: Liming
authors.affiliation: Department of Cardiovascular Surgery, Wu Han YaXin Hospital, Wuhan, China.
authors.forename: Tiao
authors.initials: T
authors.lastname: Liang
authors.affiliation: Department of Thoracic & Cardiovascular Surgery, Affiliated Hospital of Wu Han University, Wuhan, China.
authors.forename: Wang
authors.initials: W
authors.lastname: Zhiwei
authors.affiliation: Department of Cardiac Surgery, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijin, 100037, People's Republic of China.
authors.forename: Sun
authors.initials: S
authors.lastname: Hansong
authors.affiliation: Department of Cardiac Surgery, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijin, 100037, People's Republic of China.
authors.forename: Hu
authors.initials: H
authors.lastname: Shengshou
mesh_terms: D000328:Adult; D013504:Cardiovascular Surgical Procedures / Q000401:mortality*; D002681:China / Q000453:epidemiology; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000401:mortality* / Q000601:surgery*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D061646:Operative Time; D015995:Prevalence; D012307:Risk Factors; D015996:Survival Rate; D013906:Thoracoscopy / Q000379:methods / Q000401:mortality*; D016896:Treatment Outcome