Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
권호 표지
DOI QR코드

DOI QR Code

Robot-Assisted Repair of Atrial Septal Defect: A Comparison of Beating and Non-Beating Heart Surgery

  • Yun, Taeyoung (Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Kim, Hakju (Department of Thoracic and Cardiovascular Surgery, Inje University Ilsan Paik Hospital, Inje University College of Medicine) ;
  • Sohn, Bongyeon (Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Chang, Hyoung Woo (Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Lim, Cheong (Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Park, Kay-Hyun (Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine)
  • Received : 2021.09.24
  • Accepted : 2021.11.17
  • Published : 2022.02.05
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Robot-assisted repair of atrial septal defect (ASD) can be performed under either beating-heart or non-beating-heart conditions. However, the risk of cerebral air embolism (i.e., stroke) is a concern in the beating-heart approach. This study aimed to compare the outcomes of beating- and non-beating-heart approaches in robot-assisted ASD repair. Methods: From 2010 to 2019, a total of 45 patients (mean age, 43.4±14.6 years; range, 19-79 years) underwent ASD repair using the da Vinci robotic surgical system. Twenty-seven of these cases were performed on a beating heart (beating-heart group, n=27) and the other cases were performed on an arrested or fibrillating heart (non-beating-heart group, n=18). Cardiopulmonary bypass (CPB) was achieved via cannulation of the femoral vessels and the right internal jugular vein in all patients. Results: Complete ASD closure was verified using intraoperative transesophageal echocardiography in all patients. Conversion to open surgery was not performed in any cases, and there were no major complications. All patients recovered from anesthesia without any immediate postoperative neurologic symptoms. In a subgroup analysis of isolated ASD patch repair (beating-heart group: n=22 vs. non-beating-heart group: n=5), the operation time and CPB time were shorter in the beating-heart group (234±38 vs. 253±29 minutes, p=0.133 and 113±28 vs. 143±29 minutes, p=0.034, respectively). Conclusion: Robot-assisted ASD repair can be safely performed with the beating-heart approach. No additional risk in terms of cerebral embolism was found in the beating-heart group.

Keywords

References

  1. Doulamis IP, Spartalis E, Machairas N, et al. The role of robotics in cardiac surgery: a systematic review. J Robot Surg 2019;13:41-52. https://doi.org/10.1007/s11701-018-0875-5
  2. Yanagawa F, Perez M, Bell T, Grim R, Martin J, Ahuja V. Critical outcomes in nonrobotic vs robotic-assisted cardiac surgery. JAMA Surg 2015;150:771-7. https://doi.org/10.1001/jamasurg.2015.1098
  3. Morgan JA, Peacock JC, Kohmoto T, et al. Robotic techniques improve quality of life in patients undergoing atrial septal defect repair. Ann Thorac Surg 2004;77:1328-33. https://doi.org/10.1016/j.athoracsur.2003.09.044
  4. Deeba S, Aggarwal R, Sains P, et al. Cardiac robotics: a review and St. Mary's experience. Int J Med Robot 2006;2:16-20. https://doi.org/10.1002/rcs.76
  5. Kim ER, Lim C, Kim DJ, Kim JS, Park KH. Robot-assisted cardiac surgery using the da Vinci surgical system: a single center experience. Korean J Thorac Cardiovasc Surg 2015;48:99-104. https://doi.org/10.5090/kjtcs.2015.48.2.99
  6. Thapmongkol S, Sayasathid J, Methrujpanont J, Namchaisiri J. Beating heart as an alternative for closure of secundum atrial septal defect. Asian Cardiovasc Thorac Ann 2012;20:141-5. https://doi.org/10.1177/0218492311434807
  7. Cheng Y, Chen H, Mohl W, Liu X, Si Z. Totally endoscopic congenital heart surgery compared with the traditional heart operation in children. Wien Klin Wochenschr 2013;125:704-8. https://doi.org/10.1007/s00508-013-0438-8
  8. Watanabe G, Ishikawa N. Alternative method for cardioplegia delivery during totally endoscopic robotic intracardiac surgery. Ann Thorac Surg 2014;98:1129-31. https://doi.org/10.1016/j.athoracsur.2014.02.070
  9. Kim JE, Jung SH, Kim GS, et al. Surgical outcomes of congenital atrial septal defect using da VinciTM surgical robot system. Korean J Thorac Cardiovasc Surg 2013;46:93-7. https://doi.org/10.5090/kjtcs.2013.46.2.93
  10. Ma ZS, Wang JT, Dong MF, Chai SD, Wang LX. Thoracoscopic closure of ventricular septal defect in young children: technical challenges and solutions. Eur J Cardiothorac Surg 2012;42:976-9. https://doi.org/10.1093/ejcts/ezs283
  11. Ma ZS, Dong MF, Yin QY, Feng ZY, Wang LX. Totally thoracoscopic repair of atrial septal defect without robotic assistance: a single-center experience. J Thorac Cardiovasc Surg 2011;141:1380-3. https://doi.org/10.1016/j.jtcvs.2010.10.028
  12. Xiao C, Gao C, Yang M, et al. Totally robotic atrial septal defect closure: 7-year single-institution experience and follow-up. Interact Cardiovasc Thorac Surg 2014;19:933-7. https://doi.org/10.1093/icvts/ivu263
  13. Argenziano M, Oz MC, Kohmoto T, et al. Totally endoscopic atrial septal defect repair with robotic assistance. Circulation 2003;108 Suppl 1:II191-4.
  14. Seco M, Cao C, Modi P, et al. Systematic review of robotic minimally invasive mitral valve surgery. Ann Cardiothorac Surg 2013;2:704-16. https://doi.org/10.3978/j.issn.2225-319X.2013.10.18
  15. Bainbridge D, Fernandes P, Chu MW. Cardioplegia during minimally invasive mitral valve surgery, a team approach. J Cardiothorac Vasc Anesth 2018;32:664-5. https://doi.org/10.1053/j.jvca.2017.10.012
  16. Lebon JS, Couture P, Fortier A, et al. Myocardial protection in mitral valve surgery: comparison between minimally invasive approach and standard sternotomy. J Cardiothorac Vasc Anesth 2018;32:656-63. https://doi.org/10.1053/j.jvca.2017.08.040