Totally endoscopic robotic atrial septal defect repair on the beating heart.
BACKGROUND
Atrial septal defect (ASD) repairs have successfully been performed on the arrested heart with the da Vinci S Surgical System (Intuitive Surgical). This study assessed the feasibility, safety, and efficacy of the use of the da Vinci S Surgical System for on-pump ASD repairs on the beating heart without cross-clamping the aorta.


METHODS
This prospective study included 24 consecutive patients who underwent ASD repair surgery between June 2008 and June 2009. All of the procedures were completed with the da Vinci S robot via 3 port incisions in the right chest and a 1.5-cm working port. The operations were carried out on the beating heart with mild hypothermic cardiopulmonary bypass (CPB) without cross-clamping the aorta. Venting the heart from the working port provided adequate visualization of the operative field.


RESULTS
All patients underwent complete repairs. Fourteen patients underwent ASD closure with a fresh autogenous pericardial patch, and 10 patients underwent direct ASD closure. Concomitant surgery was required in 4 patients. The mean (+/-SEM) CPB time was 65.6 +/- 17.7 minutes, and the mean operative time was 98.5 +/- 19.3 minutes. No patient required transfusion of red blood cells. The length of patient stay in the intensive care unit was 0.5 to 1.0 days. The length of hospital stay was 4 to 5 days. Follow-up transthoracic echocardiography evaluations showed no residual atrial septal leakage. There were no operative deaths, strokes, or other complications. All of the patients were discharged.


CONCLUSIONS
We have shown that use of the da Vinci S Surgical System to perform on-pump ASD repairs on the beating heart without cross-clamping the aorta is feasible, safe, and effective.
Department of Cardiovascular Surgery, PLA General Hospital, PLA Institute of Cardiac Surgery, Beijing, China. gaochq301@yahoo.com
Changqing
C
Gao
Ming
M
Yang
Gang
G
Wang
Jiali
J
Wang
Cangsong
C
Xiao
Yang
Y
Wu
Jiachun
J
Li
D000293:Adolescent; D000328:Adult; D002315:Cardiopulmonary Bypass / Q000379:methods*; D002681:China; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods*; D004452:Echocardiography; D017548:Echocardiography, Transesophageal; D005240:Feasibility Studies; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D011446:Prospective Studies; D056346:Sternotomy; D013906:Thoracoscopy / Q000379:methods*; D013908:Thoracotomy; D055815:Young Adult