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Totally endoscopic robotic ventricular septal defect repair in the adult
Changqing Gao, Ming Yang.
PLA General Hospital, Beijing, China.

OBJECTIVE: After 600 case of robotic cardiac surgery with da Vinci Surgical System, the optimal results encouraged us to extend the use of this technology to more complicated patients with ventricular septal defect.
METHODS: From January 2009 to November 2013, 25 patients underwent total endoscopic robotic ventricular septal defect repair. The average patient age was 29.0±9.8 years (range, 14~45). Of the 20 patients, 9 were female and 16 were male. The echocardiogram demonstrated that the average diameter of the ventricular septal defect was 6.2±2.6mm (range, 2~15), and 4 patients had concomitant patent foramen ovale. Ventricular septal defect closure was directly secured with interrupted mattress sutures in 18 patients and patched in 7 patients. All the procedures were completed using the da Vinci robot by way of 3 port incisions and a 2.0- to 2.5-cm working port in the right side of the chest.
RESULTS: All patients were operated on successfully. The mean cardiopulmonary bypass and mean crossclamp time was 101.53±32.3 minutes (range, 66~140) and 42.6±30.1 minutes (range, 22~75), respectively. The mean operation time was 204.9±36.8 minutes (range, 180~300). The postoperative transesophageal echocardiogram demonstrated an intact ventricular septum. No residual left-to-right shunting and no permanently complete atrioventricular dissociation was found postoperatively. The mean hospital stay was 5 days. No residual shunt was found during a mean follow-up of 28 months (range, 1~49). The patients returned to normal function within 1 week without any complications.
CONCLUSIONS: Total endoscopic robotic ventricular septal defect repair in adult patients is feasible, safe, and efficacious.


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