Ventricular septal defects (VSD) are one of the most common congenital cardiac defects apart from atrial septal defect (ASD). Since the first VSD was performed by Lillehei in 1954[1], surgical repair of VSD via conventional sternotomy has become increasingly common, with low morbidity and mortality. Because of the need for favorable cosmetic effects, most adult patients, especially females, seek minimally invasive approaches for surgical repair. Currently, minimally invasive surgical options consist of mini-sternotomy, right mini-thoracotomy, and totally thoracoscopic repair for adult VSD[2-4]. Of these, totally thoracoscopic repair via small port accesses in the right chest wall minimizes surgical trauma to the greatest extent.
Nevertheless, in China, due to conservative tendencies and insufficient publicity regarding improved cosmesis, there are worries regarding the costs of increased cardiopulmonary bypass (CPB) duration and possible worse patient outcomes, even though total thoracoscopic repair has shown high rates of successful repair, low morbidity and decreased length of stay in hospital[5]. Therefore, in the present study, we explored the safety and efficacy of total thoracoscopic repair of VSDs, and compared the clinical outcomes of total thoracoscopic with those of mini-sternotomy.