Objective To compare the surgical trauma between videoassisted thoracoscopic surgery(VATS) and conventional thoracotomy, and to investigate the possible minimally invasive mechanism. Methods Seventyseven patients who had undergone consecutive operations from April 2005 to January 2006 were chosen from cardiothoracic surgery department of Fujian Provincial Hospital. Twentytwo cases had spontaneous pneumothorax diagnosed by chest X-ray examination, twentynine had patent ductus arteriosus diagnosed by color echocardiography, and twentysix had congenital atrial septal defect. According to lesions and operative methods, the patients were divided into two groups: conventional thoracotomy group(CTH group) and videoassisted thoracoscopic surgery group(VATS group). The concentrations of serum C-reactive protein（CRP），interleukin6 (IL-6)，interleukin-8（IL-8） and tumor necrosis factor-α(TNF-α) were selected as indexes to measure surgical trauma. ARRAY360 specific protein and pharmaceutical analysis system were used to determine CRP automaticly at the day before operation and on the 1st, 2nd and 3rd day after operation. Radioimmunoassay was used to measure the concentrations of IL-6，IL-8 and TNF-α. Clinical indexes such as operative time, cardiopulmonary bypass (CPB) time, intraoperative blood lost, postoperative analgesic time and hospitalization time were analyzed and compared. Results Under the condition that patients had the same diseases, there was no statistical significance in preoperative concentrations of serum CRP，IL-6，IL-8 and TNFα between VATS group and CTH group（P=0.067, 0.062, 0.053,0.064）. The concentrations of serum CRP(P=0.045,0.043,0.044), IL-6(P=0.042，0.032，0.039), IL-8(P=0.046，0.045，0.048) and TNF-α(P=0.041，0.043，0.043) on the 1st, 2nd and 3rd day after operation were significantly lower in VATS group than that in CTH group (Plt;0.05). Compared with CTH group, there were less blood lost（P=0.032）, shorter postoperative analgesic time and hospitalization time（P=0.041） in VATS group. There was no statistical significance in CPB time between two groups. However, hospitalization time varied with different diseases. Conclusion Compared with conventional thoracotomy，videoassisted thoracoscopic surgery has less surgical trauma, less intraoperative blood lost, shorter postoperative analgesic time, and can make patients recover rapidly. So it is worth spreading.
Abstract： Objective To investigate videoassisted thoracoscopic surgery (VATS) and percutaneous catheter occlusion (PCO) in interruption of patent ductus arteriosus (PDA), in order to achieve minimally invasive surgical injuries and better clinical results. Methods From November 1995 to September 2009, 312 cases of PDA were treated in Fujian provincial hospital, among whom 252 patients were interrupted with VATS(VATS group) and 60 patients with PCO technique(PCO group). For the VATS group, there were 78 males and 174 females aged from 7 d to 31 years old (9.16±8.91 years), while there were 17 males and 43 females aged from 4 to 57 years old (25.55±14.10 years) in the PCO group. We used titanium clip to interrupt PDA under videoassisted thoracoscope for patients in the VATS group, and adopted Amplatzer method for patients in the PCO group. The clinical results, complications and hospital cost in the two groups were compared in this study. Results In the VATS group, all the PDA were successfully interrupted with no residual shunt. In the PCO group, 5% (3/60) of the patients had minor residual shunt after the procedure. No mortality occurred in both groups. Time of the procedure and hospital stay in the PCO group were shorter than that in the VATS group (70.20±31.20 min vs. 112.50±16.30 min, t=6.344,P=0.002; and 4.70±2.20 d vs. 6.50±2.80 d, t=3.241, P=0.022, respectively). However, the hospital cost for each patient in the PCO group was much higher than that in the VATS group (23 222.00±4 333.40 yuan RMB vs. 8 904.50±2 634.60 yuan RMB,t=25.360, P=0.000). Conclusion Compared with PCO, VATS in interrupting PDA can achieved not only excellent clinical results, especially in the newborn and baby cases, but also very satisfying cost which is just a little more than one third of the PCO cost.
Objective\ To investigate the surgical technique and clinical results of interruption of patent ductus arteriosus (PDA) with video assisted thoracic operation (VATO).\ Methods\ Fifty PDA cases were divided into two groups, 25 cases treated with VATO(VATO group) as compared to other 25 cases with conventional surgical interruption(conventional surgical interruption group). In the VATO group, the PDA was interrupted by 2 3 hemoclips under VATO technique, and PDA interrupted by suture ligation with the techni...
Objective To compare video-assisted thoracic surgical technique (VATS) and conventional surgical technique (CSM) in mitral valve replacement (MVR). Methods We retrospectively analyzed clinical data of 93 patients in our hospital with mitral valve replacement between January 2010 and January 2015. The patients were divided into two groups including a VATS group and a CSM group.There were 43 patients with 25 males and 18 females at age of 57.43±5.65 years in the VATS group, and 50 patients with 27 males and 23 females at age of 56.40±6.32 years in the CSM group.The clinical outcomes of the two groups were compared. Results There was no mortality. Echocardiography was normal in both groups during 1-year follow-up. There was no significant difference between the two groups in the operative time, aortic clamping time, cardiopulmonary bypass (CPB) time, or ventilation time. As compared with the CSM group, the patients in the VATS group had a significantly lower complication rate, shorter chest incision length (5.23±1.36 cm vs. 18.21±3.89 cm), less blood transfusion (1.75±0.25 U vs. 3.15±1.50 U), less chest drainage (202.34±12.12 ml vs. 412.32±21.56 ml) and lower pain score (1.26±0.86 vs. 3.01±1.13), shorter time of postoperative hospital stay (8.20±2.36 d vs. 12.10±3.26 d). Conclusion MVR under VATS is not only technically feasible, but also with excellent clinical results.
Objective To analyze predictive factors, clinical implications and prognosis effects of new-onset conduction block after transcatheter aortic valve implantation (TAVI). Methods The clinical data of 86 patients who underwent TAVI through transfemoral approach from 2019 to 2021 in Fujian Provincial Hospital were retrospectively analyzed, including 59 males and 27 females with an average age of 72.9±8.0 years. The patients were divided into a normal group and a new-onset conduction block group according to whether there was new-onset conduction block after operation, and then the new-onset conduction block group was subdivided into a left bundle branch block (LBBB) group (28 patients) and a complete atrioventricular block (CAVB) group (11 patients). We compared the hemodynamics and TAVI-related complications between the postoperative and early follow-up periods, and used the multivariate logistic regression models to identify risk factors for the new-onset conduction block. Results The median EuroSCORE of all patients were 8 (2) points before the operation. In the postoperative and early follow-up periods, the hemodynamics and TAVI-related complications had no statistical difference between the new-onset conduction block group and the normal group (P>0.05). The incidence of permanent pacemaker implantation (81.8%, 9/11) and mortality due to cardiac causes (18.1%, 2/11) in the CAVB group were significantly higher than those in the normal group and theLBBB group (P<0.05). Female, severe calcification of the aortic valve, too large valve size and deep valve implants were the risk factors for new-onset conduction block after TAVI. ConclusionThe incidence of LBBB and CAVB is high after TAVI, however, both of them do not significantly effect the hemodynamics of the patients. Higher incidence of permanent pacemaker implantation is found in the CAVB group which affects the rate of rehospitalization and mortality. Female patients, severe calcification of the aortic valve, too large valve size and deep valve implants are the risk factors for the new-onset conduction block after TAVI.
Objective To investigate the effect of ginkgolide B (GB) on cysteinyl aspartate specific proteinase-3 (Caspase-3)/chromosome 10 deletion phosphatase-tension protein homologue (PTEN)/protein kinase B (Akt) pathway and cell proliferation and apoptosis in hypoxia/reoxygenation cardiomyocytes. Methods H9C2 cells were cultured in vitro. A control group was cultured in serum-free DMEM high glucose medium at 37°C and 5% CO2 for 28 hours. The remaining groups were prepared with hypoxia/reoxygenation models. A GB low-dose group and a GB high-dose group were treated with GB pretreatment with final concentration of 50 μmol/L and 200 μmol/L respectively at 1 h before hypoxia/reoxygenation. A carvedilol group was treated with carvedilol of a final concentration of 10 μmol/L at 1 h before hypoxia/reoxygenation. The proliferation and apoptosis of H9C2 cells were detected, and the levels of lactate dehydrogenase (LDH), malondialdehyde (MDA), reactive oxygen species (ROS), PTEN, Akt, phosphorylated Akt (p-Akt) and Caspase-3 in H9C2 cells were also detected. Results Compared with the control group, the proliferation rate of H9C2 cell, and the levels of PTEN, Akt and p-Akt in other groups decreased, and the apoptosis rate, and the levels of LDH, MDA, ROS and Caspase-3 increased (P<0.05). Compared with the hypoxia/reoxygenation group, the proliferation rate of H9C2 cell, and the levels of PTEN, Akt and p-Akt in all GB dose groups and the carvedilol group increased; the apoptosis rate, and the levels of LDH, MDA, ROS and Caspase-3 decreased, and the effect of GB was in a dose dependent manner; however, the effect of GB was not as strong as carvedilol (P<0.05). Conclusion GB can inhibit H9C2 cell apoptosis and promote H9C2 cell proliferation by activating Caspase-3/PTEN/Akt pathway.