The Use Of Robotics In The Surgical Correction Of Adult Congenital Cardiac Defects: Expanding The Indications
Husam H. Balkhy, Sarah Nisivaco, Gianluca Torregrossa, Narutoshi Hibino.
University of Chicago Medicine, Chicago, IL, USA.
Objective The use of a robotic assistance in the surgical repair of adult congenital cardiac anomalies is rare. There are only a few existing reports in the literature describing this approach. We describe a series of 23 patients undergoing totally endoscopic primary repair of adult cardiac congenital anomalies. Methods Between 9/2013-10/2019 23 patients underwent primary repair of adult cardiac congenital anomalies at our center, including 2 primary left partial anomalous pulmonary venous return (PAPVR), 1 ventricular septal defect (VSD) repair, 1 double-chamber right ventricle repair, and 19 ASD repairs (2 of which were unroofed coronary sinus and 2 sinus venosus ASD’s with right-PAPVR). These were all completed using a totally-endoscopic robotic-assisted approach. Demographics, intraoperative, and postoperative data were collected. Additionally, patients were contacted for mid-term follow-up. Results The mean age was 39 years and 16 (70%) were female. 3 patients had concomitant atrial fibrillation (AF), 2 were on hemodialysis, and 1 had prior mitral valve replacement. Of the 19 ASD patients, 16 had patch closure and 3 had primary closure; two had concurrent removal of a previously placed failed Amplatzer device. The 2 left PAPVR patients had an on-pump beating-heart approach. All patients underwent successful repair without conversion to sternotomy or perioperative mortality. 4 patients had concomitant procedures, 1 underwent Cryomaze for AF and 1 a tricuspid valve repair (after detaching the posterior TV leaflet) during VSD repair. Mean CPB time was 137 minutes and cardiac arrest time 70 minutes. Mean hospital and ICU length of stay were 2.9 and 1.2 days, respectively. 1 patient returned to OR for robotic evacuation of hematoma. At mean follow-up of 37 months, 20 patients reported no mortality or recurrence of symptoms; 17 had repeat echocardiography without residual shunt. Conclusions In this report we describe the successful application of robotic-assistance in totally endoscopic primary repair of 23 patients with adult congenital anomalies. The lack of mortality or conversion to sternotomy, and good midterm outcome demonstrates how this technology, already established for a myriad of adult cardiac surgeries, can be broadened and applied to other indications, such as discussed here. Further long-term studies are warranted.
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