title: Totally robotic atrial septal defect closure: 7-year single-institution experience and follow-up.
abstract: OBJECTIVE
  Robotic technology has been applied to atrial septal defect (ASD) repair for more than 10 years, but the number of cases reported is limited and results of long-term follow-up are not clear. This study reports on a large group of patients who underwent totally robotic ASD repair on an arrested or beating heart at a single institution with a 7-year follow-up.
  
  
  METHODS
  From 2007 to 2013, 160 patients (median age, 36 years; range, 11-66 years) at our centre underwent selective repair of secundum-type ASD using the da Vinci robotic system. The first 54 cases were performed on an arrested heart (arrested-heart group, n = 54) and the remainder on a beating heart (beating-heart group, n = 106). The mean diameter of defects was 2.9 cm (range, 1.1-4.1 cm). Cardiopulmonary bypass was achieved via cannulation of the femoral vessels and the right internal jugular vein. Blood cardioplegic arrest was induced using a transthoracic Chitwood clamp in the arrested-heart group. With the assistance of a robotic surgical system, atrial septal defect repairs were performed with or without tricuspid valvuloplasty via three 8-mm ports, a camera port and a working port in the right chest. Transoesophageal echocardiography was used to evaluate surgical results and follow-up.
  
  
  RESULTS
  Complete ASD closure was verified by intraoperative transoesophageal echocardiography in all patients. None of the procedures was converted to an alternate technique and there were no major complications. There were significant learning curves for cross-clamp time, operative duration and cardiopulmonary bypass time. The beating-heart group had significantly shorter operative and cardiopulmonary bypass durations than the arrested-heart group (P = 0.000). The two groups had similar durations of mechanical ventilation and intensive care unit and hospital stays, and similar drainage volumes. During the 39 ± 21 months of follow-up, no patient required reoperation because of a residual shunt or tricuspid valve regurgitation.
  
  
  CONCLUSIONS
  ASD can be performed safely and effectively on an arrested or beating heart with the assistance of robotic technology. This totally endoscopic approach represents an option for patients seeking a reliable, minimally invasive ASD repair with an excellent long-term result.
authors.affiliation: Department of Cardiovascular Surgery, the People's Liberation Army General Hospital, Beijing, China.
authors.forename: Cangsong
authors.initials: C
authors.lastname: Xiao
authors.affiliation: Department of Cardiovascular Surgery, the People's Liberation Army General Hospital, Beijing, China gaochq301@yahoo.com.
authors.forename: Changqing
authors.initials: C
authors.lastname: Gao
authors.affiliation: Department of Cardiovascular Surgery, the People's Liberation Army General Hospital, Beijing, China.
authors.forename: Ming
authors.initials: M
authors.lastname: Yang
authors.affiliation: Department of Cardiovascular Surgery, the People's Liberation Army General Hospital, Beijing, China.
authors.forename: Gang
authors.initials: G
authors.lastname: Wang
authors.affiliation: Department of Cardiovascular Surgery, the People's Liberation Army General Hospital, Beijing, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Wu
authors.affiliation: Department of Cardiovascular Surgery, the People's Liberation Army General Hospital, Beijing, China.
authors.forename: Jiali
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Cardiovascular Surgery, the People's Liberation Army General Hospital, Beijing, China.
authors.forename: Rong
authors.initials: R
authors.lastname: Wang
authors.affiliation: Department of Cardiovascular Surgery, the People's Liberation Army General Hospital, Beijing, China.
authors.forename: Minghui
authors.initials: M
authors.lastname: Yao
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D063126:Balloon Valvuloplasty; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D002648:Child; D002983:Clinical Competence; D017548:Echocardiography, Transesophageal; D004867:Equipment Design; D005260:Female; D006324:Heart Arrest, Induced; D006344:Heart Septal Defects, Atrial / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D059032:Learning Curve; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D013523:Surgical Equipment; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Atrial; Heart septal defects; Minimally invasive; Robotics; Surgical procedures