Back to 2014 Annual Meeting Posters
Minimally Invasive ASD Surgical Repair with Robotic Assistance In Adults: First Experience in Russia
Alexey N. Arkhipov, MD, PhD, Yuriy N. Gorbatykh, MD, PhD, Alexander Y. Omelchenko, MD, PhD, Alexey V. Zubritskiy, MD, Yuriy L. Naberukhin, MD, PhD, Timur S. Khapaev, MD, PhD, Alexander V. Bogachev-Prokophiev, MD, PhD, Alexander M. Karaskov, MD, PhD.
Academician Meshalkin State Research Institute of Circulation Pathology, Novosibirsk, Russian Federation.
OBJECTIVE: Robotic enhancement had advantaged the evolution of minimally invasive cardiac surgery. This report describes the experience in the first step of learning curve - robot-assisted ASD closure via minithoracotomy in adults.
METHODS: From March 2012 to November 2013, 37 patients underwent surgical ASD closure with the da Vinci surgical system (Intuitive Surgical, Sunnyvale, California). Mean age was 36,2 ± 11,9 years (range, 15-61 years) and mean body weight was 65,1 ± 12,5 kg (range, 43-95 kg). Thirty two patients had an isolated ASD with contraindications for transcatheter device closure. In five patients an ASD closure with the concomitant tricuspid valve repair was performed. Our surgical approach is a right lateral minithoracotomy in 4th intercostal space with skin incision 4 cm and three 11-mm ports for robotic instruments. Cardiopulmonary bypass was established with peripheral cannulation. The aorta was cross-clamped with the Chitwood clamp and cardiac arrest was achieved by antegrade delivery of Custodiol solution.
RESULTS: Direct closure was carried out in 4 patients, the remaining 33 had pericardial patch closure. In 5 (13,5%) patients with tricuspid valve insufficiency we used de Vega annuloplasty technique. Average cardiopulmonary bypass time was 78,9 ± 25,1 minutes (range, 42-112 minutes), mean aortic cross-clamp time was 25,1 ± 9,5 minutes (range, 14-47 minutes). No patient required conversion to a sternotomy or incision elnlargement to complete the repair. There was no mortality, no residual shunts or postoperative bleeding. There was one case of sinus node disfunction with a pacemaker implantation, one case of femoral lymphorrhea and two cases of right pneumothorax. All patients were in good clinical condition with improved functional status at discharge from the hospital.
CONCLUSIONS: Robotic technology can be utilized to perform open heart procedures safely and effectively via minithoracotomy approach. This technique could be used as an intermediate step with gaining experience to totally endoscopic procedures.
Back to 2014 Annual Meeting Posters