Three-port Totally Endoscopic Repair For Atrial Septal Defects
Junji Yanagisawa, Toshiaki Ito, Atsuo Maekawa, Masayoshi Tokoro, Takayoshi Ozeki.
Japanese Red Cross Nagoya First Hospital, Nagoya, Japan.
OBJECTIVE: Substantial percentages of patients still need surgical correction of atrial septal defect (ASD) in the era of Amplatzer septal occlusion (ASO). We assessed the validity and safety of three-port totally endoscopic repair for ASD.
METHODS: Between February 2000 and October 2016, 134 patients(median age,37.7years 48 female patient, age range 0-80 years)had surgery for ASD in our institution. 33 patients had three-port totally endoscopic surgery as minimally invasive cardiac surgery (MICS) and 101 patients had a classic surgery(CS) by median incision. Propensity matching yielded 60 matched patients (MICS vs CS ,30 vs 30).In MICS, the all patients whose body height was >140cm were adapted Early results were compared between the two groups. The surgical technique of MICS: Patient was set in partial left lateral position, and cardio-pulmonary bypass(CPB) was established through a groin incision. Three port consists of a main incision (3cm in 4th intercostal space), left-handed instrument trocar (5mm in the 3rd intercostal space), and a camera port (5mm in the 5th intercostal space). An additional venous cannula was inserted directly to superior vena cava through the main incision. ASD was closed under cardioplegic arrest, or low body-temperature ventricular fibrillation.
RESULTS: As concomitant surgeries, tricuspid annuloplasty, mitral valve repair, the Maze operation, or repair of partially anomalous pulmonary venous connection was performed in 11(36%) in MICS, and 8(26%) in CS (P=0.41). Major adverse cardiac events were 0 vs 4(13%), in MICS and CS(p=0.06). MICS needed longer cross clamp time (76.6±12 vs 33±24 min., p<0.01), and longer CPB time (128.0±26vs70.6±37 min., p<0.01). However, operation time did not differ significantly (195.8±40 vs 202±49 min., p=0.555), and MICS needed shorter post-operative hospital stay(median7.0 vs17 days, p<0.01).
CONCLUSIONS: Irrespective of longer CPB and cross-clamp time compared with CS, MICS tended to have less complication, and showed significantly quicker recovery. Compared with ASO, surgery can treat any type of ASD including type I, concomitant valvular lesions, and arrhythmia. Three-port endoscopic technique was safe and cosmetically excellent, keeping these benefits of surgical intervention.
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