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, 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; 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.