Feasibility Of Minimally Invasive Cardiac Surgery Without One Lung Ventilation
Hyung Gon Je, Sang-kwon Lee, Jong Myung Park, Mi Hee Lim.
Pusan National University Yangsan Hospital, Yangsan, Korea, Republic of.
OBJECTIVE: Minimally invasive cardiac surgery (MICS) has been more widely adopted to facilitate early recovery. For the right anterior thoracotomy approach, the one-lung ventilation (OLV) using double-lumen tube (DLT) is required but complication related to DLT is not negligible. Therefore we investigated the feasibility and efficacy of single-lumen endotracheal tube (SLT) during MICS.
METHODS: We conducted a retrospective review of clinical data of 370 patients who underwent MICS via thoracotomy between August 2009 and March 2016.Patients using SLT (n=167) were compare with DLT (n=203). In SLT group, exposure of pleural and pericardial space was assisted with intermittent lung deflation and low tidal / high frequency ventilation.
RESULTS: The preoperative variables were comparable between groups except age (SLT: 56.1 ± 15.1 vs. DLT: 51.2 ± 16.4, P=0.003), emergency (SLT: 12 (7.2%)vs. DLT: 4 (2.0%), P=0.019), and NYHA class IV (SLT: 32 (19.2%) vs. DLT: 20 (9.9%), P=0.01). There was no difference in postoperative results except duration of mechanical ventilation, and the rate of extubation in the operation room. (Table 1)
CONCLUSIONS: Comparing with insertion of a DLT, MICS with SLT provided equivalent clinical results with shorter mechanical ventilation time. MICS procedures with SLT appear to be a feasible alternative to OLV with DLT and may facilitate faster recovery.
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