Postoperative pulmonary complications after totally thoracoscopic cardiac surgery: a retrospective cohort study comparing single-lumen and double-lumen endotracheal tubes

Objective Double-lumen tubes (DLTs) are standard for one-lung ventilation in totally thoracoscopic cardiac surgery but are associated with airway injury and postoperative pulmonary complications (PPCs). This study compared perioperative outcomes between single-lumen tube (SLT)-based and DLT-based strategies in 176 adults undergoing elective totally thoracoscopic cardiac surgery (SLT, n = 94; DLT, n = 82). Methods This was a single-center retrospective cohort study. The SLT-based strategy employed a single-lumen tube with two-lung ventilation supplemented by brief, controlled intermittent lung collapse when enhanced surgical exposure was required, whereas the DLT-based strategy employed a double-lumen tube with one-lung ventilation throughout the main phase of surgery. The primary outcome was PPC incidence; secondary outcomes included airway complications and recovery metrics. Multivariable and sensitivity analyses were performed. Results Baseline characteristics were balanced. The anesthesia-to-incision time was shorter in the SLT group (57 vs. 67 min; P < 0.001). The SLT group had lower PPC incidence [29% vs. 56%; adjusted odds ratio (aOR), 0.30; 95% CI, 0.16–0.58], including lower rates of respiratory infection (7% vs. 22%) and atelectasis (18% vs. 39%). Airway complications were also less frequent (23% vs. 48%; aOR, 0.35; 95% CI, 0.18–0.68). Mechanical ventilation duration (17.5 vs. 21.0 h; P = 0.009) and ICU stay (28.0 vs. 36.0 h; P < 0.001) were shorter in the SLT group. Conclusion An SLT-based strategy was associated with improved perioperative efficiency, fewer pulmonary and airway complications, and faster recovery. These findings warrant further investigation in prospective studies.