Postoperative anxiety and depression in patients undergoing thoracoscopic closure of congenital heart defects.

BACKGROUND: Thoracoscopic closure of atrial or ventricular septal defect is a new surgical method. The postoperative mental health status of patients treated with this novel approach is presently unknown. OBJECTIVE: The aims of this study were to compare psychological symptoms between patients treated with thoracoscopy and those treated with conventional open heart surgery and to evaluate the effect of perioperative counseling on postoperative psychological symptoms. METHODS: In this prospective study, 120 patients were divided into thoracoscopic and conventional open heart surgery groups. All patients received standard preoperative and postoperative nursing care. The thoracoscopic group was randomized into study (n = 30) and control (n = 30) groups. The thoracoscopic study group received daily counseling 2 days before and within the first 4 days after the surgery. Psychological symptoms were assessed by Symptom Checklist-90 on day 5 after the surgery. RESULTS: There was no statistically significant difference in baseline characteristics or Symptom Checklist-90 scores between the thoracoscopic and conventional surgery groups (P > .05) or between the thoracoscopic study and control groups (P > .05). After surgery, the mean scores of somatization, anxiety, depression, and phobic ideation in the thoracoscopic control group were lower than in the conventional surgery group (P < .05). The mean scores of anxiety, depression, and phobic ideation in the thoracoscopic study group were lower than in the thoracoscopic control group (P < .05). CONCLUSIONS: Thoracoscopic closure of congenital heart defects is associated with less postoperative anxiety or depression symptoms compared with conventional open heart surgery. Perioperative counseling in patients undergoing thoracoscopic closure reduces postoperative anxiety or depression symptoms and should be conducted in all patients before the surgery.

Impact of nurse-initiated preoperative education on postoperative anxiety symptoms and complications after coronary artery bypass grafting.

BACKGROUND: Coronary artery bypass grafting (CABG) in high-risk patients is associated with significant perioperative complications and anxiety. Prevention of these postoperative complications and anxiety is important in the improvement of clinical outcomes following CABG. OBJECTIVE: The objective of the study was to evaluate the effect of nurse-initiated preoperative education and counseling on postoperative complications and anxiety symptoms following CABG. METHODS: In this prospective and randomized trial, 40 patients were divided into the study and control groups. All patients received standard preoperative and postoperative care, but the study group patients also completed a structured education and counseling course supervised by designated nurses 3 days before the surgery. Anxiety symptoms were assessed by Zung's self-rating anxiety scale (SAS) on the day of admission and at 3 days after the surgery. RESULTS: There was no statistically significant difference in the baseline characteristics or operational data between the 2 groups (P > .05). Following the surgery, the rate of complications such as lower extremity edema, urinary retention, constipation, respiratory infection, and deep venous thrombosis in the study group was lower than in the control group (P < .05). The mean postoperative SAS scores in the study group was lower than in the control group (40.1 [SD, 6.5] vs 48.9 [SD, 7.3]; P = .01), and the proportion of patients with a SAS score greater than 40 in the study group was also lower than in the control group (15% vs 45%, P = .041). CONCLUSIONS: Nurse-initiated preoperational education and counseling were associated with a reduced rate of perioperative complications and a reduced level of anxiety following CABG.

Totally thoracoscopic closure for atrial septal defect on perfused beating hearts.

OBJECTIVES: To investigate the feasibility and safety of non-robotically assisted totally thoracoscopic closure for atrial septal defect (ASD) on perfused beating hearts. METHODS: Twenty-four patients (8-45 years, mean 14.4 ± 18.7) underwent ASD closure on beating hearts by a totally thoracoscopic approach without the aid of a robotic surgical system. Additional 72 patients undergoing totally thoracoscopic ASD closure on cardioplegic arrested hearts were selected as a control. Cardiopulmonary bypass (CPB) was achieved peripherally. The aorta was not cross-clamped in the study group but it was cross-clamped in the control group. RESULTS: ASD closure was successful in all study and control group patients without in-hospital mortality or major complications. The total duration of operation (76 ± 9 vs. 98 ± 6 min, P = 0.012), CPB time (32 ± 5 vs. 48 ± 4 min, P = 0.001), duration of intensive care stay (10.0 ± 5.1 vs. 19.2 ± 4.2 h, P = 0.003) and post-operative hospital stay (4.5 ± 0.8 vs. 5.0 ± 1.1 days, P = 0.045) in the study group were shorter than in the control group. There was no statistically significant difference in the proportion of patients requiring in-operation blood transfusion between study group and control group (25.0 vs. 36.1%, P = 0.226). Follow-up transthoracic echocardiography on Day 5 and Day 30 showed no residual shunts in study or control group patients. CONCLUSIONS: Non-robotically assisted totally thoracoscopic closures of ASD on perfused beating hearts are feasible and safe. These procedures are associated with a shorter operation time and a shorter hospital stay than in surgeries on cardioplegic arrested hearts.

Totally thoracoscopic repair of ventricular septal defect: a short-term clinical observation on safety and feasibility.

OBJECTIVES: We sought to investigate the feasibility and safety of totally thoracoscopic repair of a ventricular septal defect. METHODS: Totally thoracoscopic repair of a perimembranous ventricular septal defect was performed in 36 patients (16 male patients; age, 5-19 years; average age, 10.2 ± 4.5 years). Patients with a pulmonary arterial systolic pressure of 60 mm Hg or greater or with supracristal or muscular ventricular septal defects were excluded. An additional 16 patients undergoing open-chest ventricular septal defect repair were selected as a control group. Through 3 port incisions in the right chest, pericardiotomy, bicaval occlusion, atriotomy, and ventricular septal defect repair were performed by a surgeon by means of thoracoscopy. RESULTS: The cardiopulmonary bypass and aortic crossclamp times were 66.2 ± 21.3 and 36.4 ± 8.2 minutes, respectively. The length of stay in the intensive care unit was 20.0 ± 4.1 hours. There were no mortalities and no major complications. Transesophageal echocardiographic analysis 5.2 ± 3.6 months after the operation showed complete closure of the defect without residual shunt. The intensive care unit (17 ± 2 vs 25 ± 5 hours, P = .01) or postoperative hospital (4.2 ± 1.1 vs 6.7 ± 2.1 days, P = .03) stays in the thoracoscopic group were shorter than in the control group. The percentage of patients who required postoperative opioid analgesics in the thoracoscopic group was lower than in the control group (37.5% vs 87.5%, P = .001). CONCLUSIONS: Totally thoracoscopic repair of a perimembranous ventricular septal defect is feasible and safe for older children. This technique is associated with a reduced intensive care and hospital stay in comparison with conventional ventricular septal defect repair.

Quality of life in patients undergoing totally thoracoscopic closure for atrial septal defect.

BACKGROUND: Quality of life in patients undergoing totally thoracoscopic closure of atrial septal defect is unclear. METHODS: Thoracoscopic atrial septal defect repair was performed in 96 patients (37 males, aged 19.4 ± 8.7 years) without the aid of a computerized robotic surgical system. An additional 56 patients (23 males, aged 21.0 ± 16.1 years) undergoing conventional atrial septal defect closure through sternotomy were enrolled as a control group. Quality of life was assessed with the Medical Outcomes Study Short Form Survey on day 60 after surgery. RESULTS: Atrial septal defect closure was successful in all patients. There was no perioperative mortality or reoperation for bleeding. Total duration of operations (98 ± 11 versus 128 ± 21 minutes, p < 0.01) and hospital stays (5.3 ± 1.7 versus 6.9 ± 2.1 days, p = 0.024) were shorter in the study group than in the control group, respectively. At discharge, patients with moderate to severe incisional pain in the study and control groups was 11.6% and 62.5%, respectively (p = 0.008). The time interval between discharge and returning to school or work in the study group was shorter than in the control group (28 ± 4 versus 42 ± 7 days, p = 0.003). The mean scores of eight variables in the Short Form Survey, such as physical function, bodily pain, social function, and general or mental health in the study group were higher than in the control group (p < 0.05 or p < 0.01). CONCLUSIONS: Compared with conventional sternotomy, totally thoracoscopic atrial septal defect closure was associated with a faster recovery of physical function and a better quality of life.

Totally thoracoscopic repair of atrial septal defect without robotic assistance: a single-center experience.

OBJECTIVE: The recent advent of robotically assisted surgery has enabled totally endoscopic repair of atrial septal defects and patent foramen ovale. This study investigates the feasibility and safety of totally endoscopic repair of an atrial septal defect through small incisions on the chest without robotic assistance. METHODS: Forty patients (23 female patients; average age, 15.4 ± 8.7 years; age range, 6-47 years) with secundum-type ASDs were selected for this study. Cardiopulmonary bypass was achieved peripherally. Through 3-port incisions in the right chest, pericardiotomy, bicaval occlusion, atriotomy, and ASD repair were performed by a surgeon through a thoracoscopy. RESULTS: The cardiopulmonary bypass and aortic crossclamp times were 56.2 ± 21.1 and 38.3 ± 8.6 minutes, respectively. The length of stay in the intensive care unit was 23.0 ± 4.1 hours. There were no mortalities and no major complications in this cohort. Patients were discharged from the hospital 4 to 6 days after the operation. Transesophageal echocardiographic analysis immediately after the operation and at 30 days showed complete closure of the defect without residual shunt. CONCLUSIONS: Totally endoscopic atrial septal defect repair can be achieved without a robotically assisted surgical system. This technique is safe and effective and can be used as a therapeutic option for ASD.