Double-lumen tubes verus single-lumen tube in patients undergoing minimally invasive cardiac surgery: A randomised, controlled clinical trial

Zhenzhong Wang¹Junfei Zhao¹Yingjie Ke¹Qiuji Wang¹Yuxin Li¹Yingxian Ye²Jianjun Zhang²Xiaogang Guo²Qingshi Zeng²Huanlei Huang^1*

• ¹Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
• ²Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China

Background: One-lung ventilation (OLV) with double-lumen tubes (DLT) are prone to complications such as airway injury and hypoxemia. It is not clear whether a two-lung ventilation (TLV) with single-lumen tube (SLT) is beneficial for patients undergoing totally endoscopic cardiac valve surgery (TECVS).We conducted a pragmatic, single-centre, single-blinded randomised controlled trial. Patients (aged ≥18 years) who underwent total endoscopic cardiac valve surgery were randomly assigned to a DLT group or a SLT group. A two-week telephone follow-up was conducted. The oxygenation index (PaO2/FiO2) was the primary outcome. The secondary outcomes included PaCO2, postoperative intubation complications, postoperative pulmonary complications and airway injury.Results: A total of 220 patients were randomly assigned. After randomisation, 20 patients were excluded, leaving 100 patients in each of the two groups. The PaO2/FiO2 were significantly greater in the SLT group than in the DLT group (P<0.001). The incidence of postoperative intubation adverse events, postoperative pulmonary atelectasis, and hoarseness was significantly lower in the SLT group (P<0.001, P=0.029 and P = 0.028, respectively).The pre-exposure time and intubation time were shorter in the SLT group (both P values <0.001). We used t test, Mann-Whitney U test and Fisher's exact test to account the difference of perioperative and follow-up outcomes.Conclusions: Two-lung ventilation with single-lumen tube is easy to perform, significantly increases oxygenation, and decreases the incidence of postoperative complications and airway injuries. Advantages remain especially for patients with preoperative pulmonary dysfunction.