Totally thoracoscopic repair of atrial septal defect reduces systemic inflammatory reaction and myocardial damage in initial patients

Abstract

BackgroundTo compare the effect of totally thoracoscopic with conventional, open repair of atrial septal defect.MethodsForty 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.ResultsAll 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).ConclusionsThoracoscopic cardiac surgery is technically feasible and safe, with less trauma and quicker recovery even when done by a surgeon newly introduced to the technique.

Bronchiolitis Associated with Mycoplasma pneumoniae Infection in Infants in Foshan China: An Epidemiologic Study

“…Myocardial injury was the most prominent extrapulmonary complication, which was more common in MP-associated bronchiolitis than in RSV-associated bronchiolitis, and emergent MP-associated bronchiolitis can cause more harm. Several studies revealed that myocardial damage was related to changes in immune function caused by inflammation [ 29 – 31 ], and this is supported by the present study, which found C-reactive protein and procalcitonin levels were elevated in patients with MP-associated bronchiolitis.…”

Total endoscopic repair of atrial septal defect under on-pump beating heart

“…Xiao et al reported a series of cases of total thoracoscopic closure of ASD on beating hearts with the da Vinci Surgical System (6). We previously reported that the total thoracoscopic ASD repair resulted in a lower level of systemic inflammatory response (SIRS) after CPB compared with conventional surgery through a sternotomy, including the level of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), interleukin-10 (IL-10), and intercellular adhesion molecule 1 (ICAM-1), and reduced the damage to tissue and organs (9).…”

“…Total endoscopic repair of atrial septal defect under on-pump beating heart cardioplegia (9). Based on the previous reports (6,10-13), we improved the techniques and skills of the total endoscopic closure for ASD on beating hearts without the assistance of a robotic surgical system which made the procedure to be much more appropriate and feasible.…”

Feasibility, safety, and short-term outcome of totally thoracoscopic mitral valve procedure

“…The totally video-assisted thoracoscopic procedure has been reported as a safe and effective method for repairing simple congenital heart defects with a rapid recovery of life quality and lower pain levels compared with both minithoracotomy and median sternotomy [15]. Meanwhile, lower systemic inflammatory reactions and myocardial damage were also observed after ASD repair with the method [16].…”