Totally Endoscopic Cardiac Surgery For Partial Atrioventricular Septal Defect Repair Without Robotic Assistance
Huy Q. Dang, Thanh N. Le, Huu C. Nguyen, Dai D. Tran.
Cardiovascular center, E hospital, Hanoi, Viet Nam.
Background: Partial atrioventricular septal defect (p-AVSD) is routinely repaired via median sternotomy. In this study, we investigated the effectivity and safety of totally endoscopic cardiac surgery without robotic assistance for p-AVSD repair.
Methods: From October 2016 to July 2017, 8 patients with p-AVSD (mean age: 9.3 ± 3.5 years and mean weight: 22.7 ± 5.2 kg) underwent totally endoscopic repair surgery without robotic assistance. Peripheral cardiopulmonary bypass (CPB) was set up with bilateral femoral arterial (FA) cannulation in 7 patients. Three 5 mm trocars and one 12 mm trocar were used, only the superior vena cava (SVC) is snared, aortic occlusion with clamp Chitwood. Mitral valves were repaired with mitral cleft closure and posterior annuloplasty. All ASDs were closed using an artificial patch, continuous suture. Follow-up time ranged from 1 to 6 months.
Results: Mean CPB time and aortic cross-clamp (ACC) time were 190 ± 46.9 (min) and 126.7 ± 18.5 (min), respectively. These patients were extubated within the first 7 hours, the volume of blood drainage on the first day was less than 70 ml. 4 days after surgery, patients did not need analgesics and were able to return to normal activities 1 week postoperatively. No AV block and residual ASD was reported. All patients have no or mild mitral valve regurgitation at the follow-up visit. Conclusions: Totally endoscopic operation for pAVSD repair is safe, with short recovery period and surgical scars are of high cosmetic value, especially in women and girls. 
Fig. Totally endoscopic surgery for p-AVSD repairing. (A), positions of trocars; (B), mitral cleft; (C), cleft was repaired with interrupted stitches; (D), posterior annuloplasty; (E), close primum ASD with an artificial patch; (F), 7 year-old boy after operation.
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