The Animal Studies And Clinical Studies Of Thoracoscopic Surgery In Pediatric Cardiac Surgery

AIM: (1) Animal model research: To compare and research the changes of liver function, renal function, soluble cytokines (TNF-α)and cell adhesion molecules (ICAM-I)after the operation of totally thoracoscopic closed of arterial septal defect and conventional surgical method. And then, conclude the effects which caused by both operative ways. (2) Clinical study: The purpose of the study is to investigate the changes of soluble cytokines(TNF-α, IL-6),cell adhesion molecules (ICAM-I)and cardiac troponin I (cTnI)in the perioperative period of the totally thoracoscopic closed of arterial septal defect in children compared with conventional surgical method. METHODS: (1) In animal research: 40 mongrel dogs were divided into two groups randomly. Group A (n=20) underwent totally thoracoscopic operation, opening holes in the right thorax, CPB, making arterial septal defect artificially and repairing it under the video-assisted thoracoscopic surgery (VATS); the group B (n=20) underwent conventional sternotomy, set up CPB and repaired the arterial septal defect in conventional ways. Collected arterial blood before and 24 hours after operation. Blood samples were taken for the determination of liver function, renal function, serocym TNF-αand serocym ICAM-I to evaluate the surgical trauma; (2) Clinical study: Forty arterial septal defect cases were divided into two groups. In the totally thoracoscopic group, twenty cases were adopted opening holes in the right thorax. The arterial catheter and one venous catheter were placed in the right femoral artery and femoral vein, the other venous catheter was placed in the superior vena cave to set up CPB. In common group, twenty cases were opened the breast bone from upper to down. The arterial catheter and two venous catheter were placed in the aortic, the superior vena cava and interior vena cava to set up CPB. Blood samples were taken for the determination of serum TNF-α, IL-6, ICAM-I, and cTn-I before operation and 2 h, 6 h, 12 h, 1 d, 2 d, 3 d, 4 d, 5 d, 6 d, and 7 d after the operation to evaluate the surgical trauma. RESULTS: (1) In animal research: There were no mortality in 24 hours after the operation. At 24 hours after the operation, The levels of bilirubin total in group were higher than group B(P<0.05); The levels of indexes of renal function in both groups were indiscriminate; The levels of TNF-αand ICAM-I at 24 hours after operation were lower than that in group B (P<0.01). (2) In clinical study: There were no mortality. In 12h after operation, the serumal level of TNF-α,IL-6,ICAM-I and cTnI of the totally thoracoscopic group are higher than the common group. But after 12h, the level of the totally thoracoscopic group decreased quickly, however, the common group's remained a higher level. CONCLUSION: (1)After the operations, the liver function of the dogs in VATS group was a little worse than common group's; The effects on renal function were similar in both groups; Pantosomatous Inflammatory reactions of the dogs in VATS group were much better than common group's. (2) Compared with conventional surgical method, the open heart operation with totally thoracoscopic assisted technique remarkably alleviated the wounds, decrease recovery time and complications.