The learning curve of minimally invasive totally thoracoscopic cardiac surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHU Ren ^1,2 ,  HUANG Huanglei ² , KE Yingjie ²

1. Department of Cardiovascular Surgery, Gaozhou People's Hospital, Gaozhou, 525200, Guangdong, P.R.China;
2. Department of Cardiovascular Surgery, Guangdong Provincial Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, P.R.China;

Corresponding?author：

HUANG Huanglei, Email: hhuanlei@hotmail.com

Keywords：

Totally video-assisted thoracoscopic cardiac surgery; minimally invasive cardiac surgery; learning curve; quality control

DOI：

10.7507/1007-4848.201710006

Video：

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Objective To monitor surgical quality and analyze learning curve of minimally invasive totally thoracoscopic cardiac surgery. Methods We retrospectively analyzed the clinical data of 150 consecutive patients who underwent minimally invasive totally thoracoscopic cardiac surgery in the Guangdong General Hospital between January 2013 and December 2015. There were 60 males and 90 females at age of 43.1 years. There were 60 patients with atrial or ventricular septal defect repair, 12 patients with cardiac tumor resection, 53 patients with mitral valve replacement and 25 patients with mitral valve repair. According to the surgical sequence, all the patients were divided into 3 groups including a group A, group B, and group C with 50 patients in each group (every 10 patients as a sequence, every 5 sequence as a group). Surgical outcomes were compared among the 3 groups, and surgical quality was analyzed with descriptive statistics. Results Surgical failure rate was 6.7% (10/150). There was no in-hospital mortality. Aortic cross-clamp time, cardiopulmonary bypass time and duration of mechanical ventilation, duration of ICU stay, duration of hospital stays of the group C were significantly shorter than those of the group A and group B. Analysis showed a significant learning curve effect in totally thoracoscopic cardiac surgery. When surgical cases reached about 100 cases, cardiopulmonary bypass and aortic cross-clamp time was shorter than the average value stably. Conclusion Totally thoracoscopic cardiac surgery is safe and reliable. For the beginners, it needs about 100 patients of surgery to master the totally thoracoscopic cardiac surgery.

Citation： ZHU Ren, HUANG Huanglei, KE Yingjie. The learning curve of minimally invasive totally thoracoscopic cardiac surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2018, 25(9): 791-794. doi: 10.7507/1007-4848.201710006 Copy

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2.	Sündermann SH, Czerny M, Falk V. Open vs. minimally invasive mitral valve surgery: surgical technique, indications and results. Cardiovasc Eng Technol, 2015, 6(2): 160-166.
3.	Akowuah E, Burdett C, Khan K, et al. Early and late outcomes after minimally invasive mitral valve repair surgery. J Heart Valve Dis, 2015, 24(4): 470-477.
4.	Iribarne A, Easterwood R, Russo MJ, et al. Comparative effectiveness of minimally invasive versus traditional sternotomy mitral valve surgery in elderly patients. J Thorac Cardiovasc Surg, 2012, 143(4 Suppl): S86-S90.
5.	Rogers CA, Reeves BC, Caputo M, et al. Control chart methods for monitoring cardiac surgical performance and their interpretation. J Thorac Cardiovasc Surg, 2004, 128(6): 811-819.
6.	Yao F, Wang J, Yao J, et al. Video-assisted thoracic surgical lobectomy for lung cancer: description of a learning curve. J Laparoendosc Adv Surg Tech A, 2017, 27(7): 696-703.
7.	Gezer S, Avc? A, Türktan M. Cusum analysis for learning curve of videothoracoscopic lobectomy. Open Med (Wars), 2016, 11(1): 574-577.
8.	Murzi M, Cerillo AG, Bevilacqua S, et al. Traversing the learning curve in minimally invasive heart valve surgery: a cumulative analysis of an individual surgeon's experience with a right minithoracotomy approach for aortic valve replacement. Eur J Cardiothorac Surg, 2012, 41(6): 1242-1246.
9.	Holzhey DM, Seeburger J, Misfeld M, et al. Learning minimally invasive mitral valve surgery: a cumulative sum sequential probability analysis of 3895 operations from a single high-volume center. Circulation, 2013, 128(5): 483-491.
10.	Nishida H, Nakatsuka D, Kawano Y, et al. Outcomes of totally endoscopic atrial septal defect closure using a glutaraldehyde-treated autologous pericardial patch. Circ J, 2017, 81(5): 689-693.
11.	Kodaira M, Kawamura A, Okamoto K, et al. Comparison of clinical outcomes after transcatheter vs. minimally invasive cardiac surgery closure for atrial septal defect. Circ J, 2017, 81(4): 543-551.
12.	Santana O, Krishna R, Kherada N, et al. Outcomes of minimally invasive valve surgery in patients with multiple previous cardiac operations. J Heart Valve Dis, 2016, 25(4): 487-490.
13.	Santana O, Xydas S, Williams RF, et al. Minimally invasive valve surgery in high-risk patients. J Thorac Dis, 2017, 9(Suppl 7): S614-S623.
14.	Moscarelli M, Fattouch K, Casula R, et al. What is the role of minimally invasive mitral valve surgery in high-risk patients? A meta-analysis of observational studies. Ann Thorac Surg, 2016, 101(3): 981-989.

1. Jung JC, Kim KH. Minimally invasive cardiac surgery versus conventional median sternotomy for atrial septal defect closure. Korean J Thorac Cardiovasc Surg, 2016, 49(6): 421-426.
2. Sündermann SH, Czerny M, Falk V. Open vs. minimally invasive mitral valve surgery: surgical technique, indications and results. Cardiovasc Eng Technol, 2015, 6(2): 160-166.
3. Akowuah E, Burdett C, Khan K, et al. Early and late outcomes after minimally invasive mitral valve repair surgery. J Heart Valve Dis, 2015, 24(4): 470-477.
4. Iribarne A, Easterwood R, Russo MJ, et al. Comparative effectiveness of minimally invasive versus traditional sternotomy mitral valve surgery in elderly patients. J Thorac Cardiovasc Surg, 2012, 143(4 Suppl): S86-S90.
5. Rogers CA, Reeves BC, Caputo M, et al. Control chart methods for monitoring cardiac surgical performance and their interpretation. J Thorac Cardiovasc Surg, 2004, 128(6): 811-819.
6. Yao F, Wang J, Yao J, et al. Video-assisted thoracic surgical lobectomy for lung cancer: description of a learning curve. J Laparoendosc Adv Surg Tech A, 2017, 27(7): 696-703.
7. Gezer S, Avc? A, Türktan M. Cusum analysis for learning curve of videothoracoscopic lobectomy. Open Med (Wars), 2016, 11(1): 574-577.
8. Murzi M, Cerillo AG, Bevilacqua S, et al. Traversing the learning curve in minimally invasive heart valve surgery: a cumulative analysis of an individual surgeon's experience with a right minithoracotomy approach for aortic valve replacement. Eur J Cardiothorac Surg, 2012, 41(6): 1242-1246.
9. Holzhey DM, Seeburger J, Misfeld M, et al. Learning minimally invasive mitral valve surgery: a cumulative sum sequential probability analysis of 3895 operations from a single high-volume center. Circulation, 2013, 128(5): 483-491.
10. Nishida H, Nakatsuka D, Kawano Y, et al. Outcomes of totally endoscopic atrial septal defect closure using a glutaraldehyde-treated autologous pericardial patch. Circ J, 2017, 81(5): 689-693.
11. Kodaira M, Kawamura A, Okamoto K, et al. Comparison of clinical outcomes after transcatheter vs. minimally invasive cardiac surgery closure for atrial septal defect. Circ J, 2017, 81(4): 543-551.
12. Santana O, Krishna R, Kherada N, et al. Outcomes of minimally invasive valve surgery in patients with multiple previous cardiac operations. J Heart Valve Dis, 2016, 25(4): 487-490.
13. Santana O, Xydas S, Williams RF, et al. Minimally invasive valve surgery in high-risk patients. J Thorac Dis, 2017, 9(Suppl 7): S614-S623.
14. Moscarelli M, Fattouch K, Casula R, et al. What is the role of minimally invasive mitral valve surgery in high-risk patients? A meta-analysis of observational studies. Ann Thorac Surg, 2016, 101(3): 981-989.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

The learning curve of minimally invasive totally thoracoscopic cardiac surgery

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