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OBJECTIVE: Robotic ASD repair has been performed since the late 20th century,most often in simple Secundum ASDs, and most often without a patch. Persistent LSVC has been a contraindication to repair, because of the technical difficulty associated with venous drainage into the coronary sinus. We herein describe a novel technique for venous cannulation to allow for robotic, endoscopic patch repair of a Sinous Venosus ASD in the setting of a persistent LSVC.
METHODS: This is retrospective review of 2 cases and a video/oral description of our operative technique. The left SVC was cannulated through the left IJ with a 15 Fr arterial cannula Y-ed together with a right IJ 15 Fr arterial cannula and femoral venous cannulas (25 Fr). Together with femoral arterial cannulation, and balloon occlusion, this makes possible a totally endoscopic, port access approach to complicated ASD repair.
RESULTS: Both patients were successfully repaired endoscopicly with the Robot, without complication. O.R. times were 5h,36m,and 6h,30m, crossclamp times were 66m and 65m, CPB times were 98m, and 138m. There were no transusions and both patients were discharged home on day 8 and 7 postoperative.
CONCLUSIONS: Although venous cannulation is more complicated, it is possible to repair complex ASDs with PAPVR and persistent LSVC with minimally invasive, nonsternotomy techniques, and our preferred approach utilizes Robotic assistance.