Robotic Repair Of Partial Anomalous Pulmonary Venous Connection
Burak Onan, Ünal Aydın, Ersin Kadirogullari, Ismahan Selen Onan, Onur Şen.
Istanbul SBU Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Hospital, Istanbul, Turkey.
BACKGROUND-This study reports our initial experience with robotic-assisted partial anomalous pulmonary venous connection (PAPVC) repair. METHODS-From May 2013 through December 2019, 24 patients (15 male and 9 female) underwent robotic-assisted repair of a right-sided (n = 23) or a left-sided (n = 1) PAPVC. The mean age was 28.2 ± 6.5 years (range 14-44) and the mean body mass index was 22.3 ± 4.6. Twenty patients had a right-sided supra-cardiac PAPVC with sinus venosus atrial septal defect, three had a right-sided cardiac PAPVC to the right atrium and one had a left-sided cardiac PAPVC to the coronary sinus. Associated anomalies included patent foramen ovale (n = 3) and left persistent superior vena cava (n = 2). RESULTS-All patients were operated on successfully. No conversion to mini-thoracotomy or sternotomy was needed. Cardiopulmonary bypass and aortic clamping times were 110.4 ± 14.2 (range 85-150) and 63.5 ± 12.4 (range 44-90) minutes, respectively. Repair techniques included the single-patch repair with baffle through right atriotomy (n = 17), the 2-patch repair (n = 3) using lateral transcaval incision and intracardiac re-routing (n = 4). The mean ventilation time was 4.1± 1.3 h and hospital stay was 3.1 ± 0.1 days. No phrenic nerve injury, sinus node dysfunction, re-exploration or blood transfusion was noted. No residual shunting or venous obstruction was found on echocardiograms. Follow-up was a mean of 1.6 years (range 1-36 months). There was no follow-up mortality. Totally, endoscopic robotic-assisted PAPVC repair is a feasible procedure in selected adult patients. CONCLISIONS-It is a less invasive alternative to traditional incisions, mini-thoracotomy and endoscopic approaches. In the future, new generation robotic devices may offer an alternative for younger patients with this pathology.
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