Totally thoracoscopic surgery for the treatment of atrial septal defect without of the robotic Da Vinci surgical system

摘要

Background More and more surgeons and patients focus on the minimally invasive surgical techniques in the 21st century. Totally thoracoscopic operation provides another minimal invasive surgical option for patients with ASD (atrial septal defect). In this study, we reported our experience of 61 patients with atrial septal defect who underwent totally thoracoscopic operation and discussed the feasibility and safety of the new technique. Methods From January 2010 to October 2012, 61 patients with atrial septal defect underwent totally thoracoscopic closure but not traditional median sternotomy surgery. We divided the 61 patients into two groups based on the operation sequence. The data of group A (the first 30 cases) and group B (the last 31 cases). The mean age of the patients was 35.1鈥壜扁€?2.8 years (range, 6.3 to 63.5 years), and mean weight was 52.7鈥壜扁€?1.9 kg (range, 30.5 to 80 kg). Mean size of the atrial septal defect was 16.8鈥壜扁€?1.3 mm (range, 13 to 39 mm) based on the description of the echocardiography. Results All patients underwent totally thoracoscopy successfully, 36 patients with pericardium patch and 25 patients were sutured directly. 7 patients underwent concomitant tricuspid valvuloplasty with Key technique. No death, reoperation or complete atrioventricular block occurred. The mean time of cardiopulmonary bypass was 68.5鈥壜扁€?9.1 min (range, 31.0 to 153.0 min), the mean time of aortic cross-clamp was 27.2鈥壜扁€?1.3 min (range, 0.0 to 80.0 min) and the mean time of operation was 149.8鈥壜扁€?5.7 min (range, 63.0 to 300.0 min). Postoperative mechanical ventilation averaged 4.9鈥壜扁€?.5 hours (range, 3.5 to 12.6 hours), and the duration of intensive care unit stay 20.0鈥壜扁€?.8 hours (range, 15.5 to 25 hours). The mean volume of blood drainage was 158鈥壜扁€?8 ml (range, 51 to 800 ml). No death, residual shunt, lung atelectasis or moderate tricuspid regurgitation was found at 3-month follow-up. Conclusion The totally thoracoscopic operation is feasible and safe for patients with ASD, even with or without tricuspid regurgitation. This technique provides another minimal invasive surgical option for patients with atrial septal defect.