In order to further improve the treatment level of rib, sternum, and lung trauma in China, and to provide patients with a comprehensive, safe, scientific, and standardized treatment model, we convened a meeting of outstanding thoracic surgery experts in the field of trauma in China to demonstrate and solicit opinions widely, and in accordance with the principle of evidence-based medicine, based on the best published Chinese and English evidence, finally formulated this consensus. This consensus aims to solve the possible problems in the treatment of lung, rib, and sternum trauma to the greatest extent, and provide scientific and standard clinical solutions for the treatment of thoracic surgery trauma.
Objective To evaluate the risk factors for sternal wound infections after various cardiac operations. Methods We retrospectively analyzed the clinical data of 2 924 consecutive patients (28% female) in our hospital from 2010 to 2014 year. Their median age was 69 years (interquartile range of 60 to 76 years). Procedures included isolated coronary artery bypass grafting (CABG), isolated valve repair or replacement, and valve procedures plus CABG. Results Sternal wound infection was detected in 110 (3.8%) patients among the 2 924 patients: 67 of 1 671 patients (4.0%) after CABG, 17 of 719 (2.4%) after valve operations, and 26 of 534 (4.9%) after valve+CABG operation. In the CABG patients, bilateral internal thoracic artery harvest procedure, operation time>300 minutes, diabetes, obesity, chronic obstructive pulmonary disease, and female were independent risk factors for sternal wound infection. In the valve operation patients, only revision for bleeding as an independent predictor for sternal infection. For combined valve plus CABG patients, revision for bleeding and operation time>300 minutes were independent risk factors for sternal infection. Conclusion Risk factors for sternal wound infections after cardiac operations vary with the type of surgical procedure. In patients undergoing valve operations or combined operations, procedure-related risk factors (revision for bleeding, operation time) independently predict infection. In patients undergoing CABG, not only procedure-related risk factors but also bilateral internal thoracic artery harvest and patient characteristics (diabetes, chronic obstructive pulmonary disease, obesity, female) are predictors of sternal wound infection. Preventive interventions may be justified according to the type of operation.
ObjectiveTo evaluate the advantages and disadvantages of parasternal minimally incision surgery over median sternotomy to treat atrial septal defect (ASD) patients. MethodsWe retrospectively analyzed the clinical data of 55 ASD patients received ASD closure under cardiopulmonary bypass (CPB) in Department of Cardiovascular Surgery, West China Hospital from November 2010 through March 2014. There were 16 males and 39 females with an average age of 25.8 (range, 9-56 years). All the patients were divided into two groups depending on different surgical approach:a median sternotomy group (a MS group, 15 patients)and a parasternal minimally incision group (a PMI group, 40 patients). There was no statistical difference in age, gender, weight, cardiac function classification (NYHA), and atrial septal defect diameter between the two groups (P>0.05). We analyzed the clinical data of the patients and followed up for 6 months. ResultsAfter operation, no death occurred in the two groups. One patient in the MS group prolonged hospitalization due to poor postoperative heart function. One patient in the PMI group prolonged hospitalization because of pulmonary infection. Patients in the PMI group had longer operation time (P=0.007) and cardiopulmonary bypass (CPB) time (P < 0.001), higher cost in hospital (P=0.040), less intraoperative blood loss, less postoperative drainage volume on the first day (both P < 0.001). There was no statistical difference in aortic clamp time (P=0.500) mean hospital stay (P=0.290) after operation between the two groups. To eliminate the interference of the learning curve, there was no statistical difference in operation time (P=0.275) and hospitalization cost (P=0.188) between the two groups. While there was a statistical difference in CPB time between the two groups (P=0.007). There was no remnant shunts or wound complications in the two groups at the end of following up for 6 months. More patients in the PMI group could engage in non-strenuous activities with a statistical difference (P < 0.001). ConclusionParasternal minimally incision in the treatment of atrial septal defect is safe, effective, minimally invasive, with easy operation and shorter learning curve. It can be used as an important part of minimally invasive treatment procedure of congenital heart disease.
ObjectiveTo examine the safety, efficacy and durability of totally endoscopic minimally invasive (TEMI) mitral valve repair in Barlow’s disease (BD). MethodsA retrospective study was performed on patients who underwent mitral valve repair for BD from January 2010 to June 2021 in the Guangdong Provincial People’s Hospital. The patients were divided into a MS group and a TEMI group according to the surgery approaches. A comparison of the clinical data between the two groups was conducted. ResultsA total of 196 patients were enrolled, including 133 males and 63 females aged (43.8±14.9) years. There were 103 patients in the MS group and 93 patients in the TEMI group. No hospital death was observed. There was a higher percentage of artificial chordae implantation in the TEMI group compared to the MS group (P=0.020), but there was no statistical difference between the two groups in the other repair techniques (P>0.05). Although the total operation time between the two groups was not statistically different (P=0.265), the TEMI group had longer cardiopulmonary bypass time (P<0.001) and aortic clamp time (P<0.001), and shorter mechanical ventilation time (P<0.001) and postoperative hospitalization time (P<0.001). No statistical difference between the two groups in the adverse perioperative complications (P>0.05). The follow-up rate was 94.2% (180/191) with a mean time of 0.2-12.4 (4.0±2.4) years. Two patients in the MS group died with non-cardiac reasons during the follow-up period. The 3-year, 5-year and 10-year overall survival rates of all patients were 100.0%, 99.2%, 99.2%, respectively. Compared with the MS group, there was no statistical difference in the survival rate, recurrence rate of mitral regurgitation, reoperation rate of mitral valve or adverse cardiovascular and cerebrovascular events in the TEMI group (P＞0.05). ConclusionTEMI approach is a safe, feasible and effective approach for BD with a satisfying long-term efficacy.
ObjectiveTo investigate the effect of delayed sternal closure (DSC) on sternal wound debridement after pediatric cardiac surgery. MethodsWe retrospectively analyzed clinical data of 491 pediatric patients underwent DSC in Guangdong General Hospital between June 2009 and June 2014. There were 333 males and 158 females with age of 1 day to 153.37 (5.68±17.24) months. The rate of sternal wound debridement between the DSC patients and the non-DSC patients was compared. ResultsA total of 454 pediatric patients with DSC initiated in the operation room. And 37 patients with DSC initiated in intensive care unit after emergency sternotomy. A total of 392 patients with delayed sternal closure were discharged. Eight patients gave up treatment for family reasons and 91 patients died. Patients with DSC had higher incidence of sternal wound debridement than the patients with non-DSC did (χ2=6.693, P=0.010). ConclusionDSC is an effective treatment for children with severe cardiac surgery, while it causes higher incidence of sternal wound debridement.
Objective To investigate surgical indications，techniques，safety and clinical outcomes of minimallyinvasive sternal lowering operation for the treatment of pectus carinatum （PC）. Methods Clinical data of 40 PC patientswho underwent minimal invasive sternal lowering operation in Xinhua Hospital，School of Medicine，Shanghai Jiao Tong University from July 2009 to August 2012 were retrospectively analyzed. There were 39 male patients and 1 female patientwith their average age of 14.5 （12-22）years. All the patients underwent their surgical correction for the first time，and their chest deformity were characterized by a significant protrusion of the sternum and ribs including 21 symmetric and 19 asymmetric protrusions. Preoperative evaluation included electrocardiogram，CT scan of the chest，echocardiogram and pulmonary function test. Preoperative mean Haller index was 1.91±0.23. Sixteen patients had mild restrictive ventilatory disorder. Allthe patients received minimally invasive sternal lowering operation with a curved Nuss steel bar. Aggravating activities wererestricted within 3 months postoperatively，and the steel bar was removed 2 years later. Results All the operations were completed successfully，and thoracic appearance was significantly improved after correction. All the patients and their relativeswere very satisfied with the corrective outcomes. The operation time was 65-115 （82.0±15.6）minutes and average intraop-erative blood loss was less than 10 ml. Postoperative hospital stay was 3-5 （3.5±0.8） days. Postoperative Haller index was2.39±0.17，which was significantly higher than preoperative Haller index （P＜0.01） . Postoperative complications included wound infection in 2 patients，pneumothorax in 1 patient （cured by closed thoracostomy），subcutaneous effusion in 3 patients，and persistent pain （longer than 14 days） in 2 patients. There was no other serious postoperative complication. All the 40 patients were followed up for 3-36 months after discharge. A steel bars was removed ahead of schedule because of wound infection in one patient. Other steel bars were in normal position in 39 patients and there was no displacement of the steel bars or the stabilizers. Eight patients received removal of the steel bars without PC recurrence. Conclusion Juveniles with PC who have good chest wall compliance are the best candidates for minimally invasive sternal lowering operation which is an easy，safe，reliable，minimally invasive and esthetic procedure with satisfactory corrective outcomes.
Objective To explore the advantage of transection the cervical muscles at sternal end and flip fixed in therapeutic bilateral huge thyroid surgery. Methods The transection of the cervical muscles at sternal end and flip fixed in 53 cases was observation group， 44 cases of the neck white line incision thyroid surgery completed for the control group. The completion of the surgery by the same group of physicians. The operative time， operation field of exposing effect， amount of bleeding in operation， postoperative complications， and postoperative drainage volume were compared between two groups. Results There was no statistically differences of sex， age， disease composition， and tumor size between two groups （P＞0.05）. Operative time， amount of bleeding， and postoperative drainage volume in observation group were shorter （less） than that in control group （P＜0.01）. The postoperative complication rate in observation group was lower than that in control group（P=0.04）. Surgical field exposure in observation group was better than that in control group （P＜0.01）. Conclusions The huge bilateral thyroid surgery with the sternal end approach is feasible and simple. The operation field exposure is better than the white line neck incision， complications after operation is less. It is worthy of clinical application.
ObjectiveTo analyze the safety and effectiveness of minimally invasive small incision through the right third intercostal and standard aortic valve replacement.MethodsThe clinical data of 123 patients with the first simple aortic valve replacement in our hospital from June 2013 to May 2020 were retrospectively analyzed. The patients receiving aortic valve replacement through the right third intercostal small incision were allocated to a minimally invasive group, and patients receiving aortic valve replacement through the median sternal incision were allocated to a common group. The clinical outcomes of the two groups were compared.ResultsThere were 40 patients in the minimally invasive group, including 11 (27.5%) females and 29 (72.5%) males, aged 54.60±9.98 years with the body mass index (BMI) of 23.16±2.48 kg/m2. There were 83 patients in the common group, including 27 (32.5%) females, 56 (67.5%) males, aged 58.77±9.71 years, with the BMI of 24.13±3.13 kg/m2. Compared with the common group, the aortic cross-clamping time, cardiopulmonary bypass time, and operation time were longer (P<0.05), the ventilator support time was shorter (P<0.05), and the blood loss, postoperative 24 h chest drainage volume and total expense were less (P<0.05) in the minimally invasive group. The ICU stay, postoperative hospital stay, and total hospital stay were not statistically different between the two groups (P>0.05).ConclusionThe aortic valve replacement through the right third intercostal small incision is safe and effective, with less blood loss, 24 h chest drainage volume and invasiveness.