Objective: To evaluate the learning curve and safety of total thoracoscopic mitral valve repair (MVP). Background: Total thoracoscopic MVP is characterized by minimal trauma, minimal bleeding, and short postoperative recovery time. The learning curve of any new procedure needs to be evaluated for learning and replication. However, minimally invasive mitral valve technique is a wide-ranging concept, no further analysis of the outcomes and learning curve of total thoracoscopic mitral valve repair has been performed. Methods: One hundred and fifty consecutive patients who underwent minimally invasive MVP alone without concurrent surgery were evaluated. Using Cardiopulmonary bypass (CPB) time and Aortic clamping (AC) time as evaluation variables, we visualized the learning curve for total thoracoscopic MVP using Cumulative sum analysis. We also analyzed important postoperative variables such as postoperative drainage, duration of mechanical ventilation, ICU stay and postoperative hospital stay. Results: The slope of the fitted curve was negative after 75 procedures, and the learning curve could be crossed after the completion of the 75th procedure when AC and CPB time were used as evaluation variables. And as the number of surgical cases increased, CPB, AC, postoperative drainage, duration of mechanical ventilation, ICU stay and postoperative hospital stay all showed different degrees of decrease. The incidence of postoperative adverse events is similar to conventional mitral valve repair. Conclusions: Compared to conventional MVP, total thoracoscopic MVP provides the same satisfactory surgical results and stabilization can be achieved gradually after completion of the 75th procedure.

Background: With the promotion of minimally invasive concepts and advances in total thoracoscopic valve surgery, total thoracoscopic aortic valve surgery has become a new option for patients with aortic valve lesions. However, due to its anatomical characteristics, poor surgical field exposure and limited operating space, only a few centers have performed further studies on this procedure. Methods: We evaluate the safety and advantages of total thoracoscopic aortic valve replacement compared to the upper mini-sternotomy AVR group and the conventional AVR group with important perioperative data as well as early postoperative outcomes. Results: All patients successfully underwent elective surgery, with no intraoperative conversion or death occurring. Patients in the total thoracoscopy group had significantly prolonged CPB and aortic clamping (AC) times compared to the other two groups. The average Postoperative chest drainage in the first 24 h of the total thoracoscopic group was significantly less than the other two groups. The mean VAS pain score in the total thoracoscopic group was significantly less than the other two groups. In addition, the total thoracoscopic group had a significantly decreased ICU stay as well as the total hospital stay. Although the length of mechanical ventilation between groups did not show statistically significant differences, mechanical ventilation in the total thoracoscopy group had a smaller relative number. Conclusions: Despite the need for improvement, total thoracoscopic aortic valve replacement is safe, and may improve clinical outcome

Background: The weekend effect is a phenomenon characterized by increased early all-cause mortality among patients hospitalized or undergoing surgery over the weekend for emergencies. Objectives: With this meta-analysis we aimed to determine whether weekend hospitalization/surgery due to acute aortic syndromes (AAS) is associated with increased early all-cause mortality. Methods：Major electronic databases were searched for studies published up to October 2020 reporting early all-cause mortality rates for admissions/operations on weekends versus weekdays. Data were pooled using fixed- and random-effects models. The primary outcome of the study was early all-cause mortality after weekend versus weekday. Results: All the included studies were retrospective, comparative or cohort studies enrolling patients admitted or underwent surgery for AAS and reported early all-cause mortality after weekend (including holiday) versus weekday. A total of 18 studies including a total of 252807 patients were identified. This meta-analysis showed a significant increase in the early all-cause mortality for patients admitted/conducted surgery for AAS on weekends compare with weekdays (fixed-effect: OR 1.1;95% CI 1.06-1.14;P＜0.00001). Conclusion: Weekend admission/surgery for AAS is associated with a increased risk of early all-cause mortality.