Phẫu thuật nội soi toàn bộ không có robot hỗ trợ, tim đập vá thông liên nhĩ: kinh nghiệm ở một trung tâm

Abstract

Objectives: Totally endoscopic surgery (TES) has not been applied much for the treatment of congenital heart diseases (CHD). In this study, we evaluate the safety and efficacy of the application of TES on the beating heart, without the assistance of robotic system for the treatment of atrial septal defect (ASD).

Subjects and study method: 60 patients (adults/children: 41/19; mean age: 29.1 ± 18.7, ranged from 2 to 61 years old) diagnosed with secundum ASD were enrolled in our study.There were 38 patients with isolated ASD, 4 patients had concomitant partial anomalous pulmonary venous return, 17 patients had ASD associated with severe tricuspid regurgitation. Peripheral extracorporeal circulation was established. Three 5mm trocars and one 12mm trocar were placed, only the superior vena cava (SVC) was snared, the pleural space was filled with CO2, the heart was beating during surgery. The defect was closed by an artificial patch, continuous suture, the anomalous pulmonary veins were drained to left atrium by constructing a tunnel, tricuspid valve repair using annular ring placement or De Vega method.

Results: No surgery-related complications or death was noted. Mean operation time and cardiopulmonary bypass time were 234.2 ± 54.3 (minutes) and 132 ± 46.9 (minutes), respectively. Patients were extubated within the first 4 hours post-operation, the volume of blood drainage in the first day was less than 80ml. Four days after surgery, patients did not need any analgesics and can return to normal daily activities 1 week postoperatively.

Conclusion: TES for ASD closure on the beating heart is safe, patients recovered quickly, surgical scars were of high aesthetic value, especially in women and young girls.