Comparative Study Of Pulmonary Function VATS Heart Surgery And Conventional Thoracotomy

Objective Video assisted thoracoscopic cardiac surgical operation began since the early nineteen nineties and most operation in cardiac surgical field can be performed at present. It is still unknown whether this new operation mode has influence on patient’s respiration compared with the routine method. The new operation method has several shortcomings which maybe have bad effect on the respiration including unilateral ventilation, different postures, lung compression, mechanical damage and destruction of the closed pleural cavity. In this study several factors including Oxygenation index(OI), Alveolararterial oxygen tension gradient(P(A-a) O2), Respiratory index(RI) and Maximum Ventilatory Volume(MVV) were used to evaluate the effect on the lung function for open heart surgery with extracorporeal circulation by thoracoscopic approach.Method58cases of heart disease from dec.2012to sep.2013were studied. All the patients were devided into two groups (thoracoscopic minimally invasive small incision group, conventional median incision group)according to the different incision technique.01,(P(A-a) O2and RI were tested at five time points including preoperation, pior to cardiopulmonary bypass,10minutes before aortic opening cardioversion,30min after operation,3h after operation. Three factors including FVC,EFV1,MVV were tested to evaluate pulmonary function at preoperation and the sixth day after operation. The results of the two groups were compared to assess the different effect on the lung function between video assisted cardiac operation and traditional open chest operation.Results The comparison of preoperative PF between the two groups was no statistically significance. The postoperative PF of routine group was significantly lower than endoscopic group. There was statistically significance for FVC and MVV, but no statistically significance for FEV1between the two groups. For each group the PF of preoperation and postoperation was compared. In routine group the postoperative PF was lower than the preoperative PF and a statistically significance was found. The postoperative PF was lower than the preoperative PF in the endoscopic group,but no statistically significance. The comparisons of RI,OI, P (A-a) O2between the two groups at the time point of preoperation and pior to cardiopulmonary bypass were no statistically significance. But at the time point of postoperation the RI, P(A-a)O2rised and OI falled which indicated that the PF were decreased obviously. The statistical significance was showed for RI at the time point of30minutes after operation between the two groups. The comparison of P(A-a)O2at3h after operation between the two groups was statistically significant. Both RI and P(A-a)O2had no statistically significance at other time point. Statistical signifiances of01were found between the two groups at the three time points(10minutes after heart back,30minutes after operation,3h after operation).Conclusions Two kinds of operation mode had statistically significant effect on the recovery of pulmonary function after surgery, VATS(video-assisted thoracoscopic surgery)group recovered more quickly than the open chest group. From the blood gas index, there was no obvious difference between the two groups of the effect on PF at early postoperation. The PF recovery of VATS group was better than the median thoracotomy group at the sixth day after operation.