Short-term results of totally endoscopic ventricular septal defect repair at the Cardiovascular Center, E Hospital

Abstract

Introduction: Ventricular septal defect (VSD) is the most common congenital heart defect. Various treatment strategies have been applied, with the choice depending on defect location, patient condition, and institutional resources. With advances in anesthesia, perioperative care, and surgical techniques, most VSD cases in small children (<15 kg) can now be effectively treated via minimally invasive right axillary thoracotomy. However, in older or heavier patients (>15 kg), exposure through the axillary approach is technically challenging, whereas median sternotomy remains highly invasive. In this context, totally endoscopic surgery has emerged as a less invasive alternative, providing faster recovery and improved cosmetic outcomes.

Methods: We conducted a retrospective descriptive study from January 2020 to December 2024 at the Cardiovascular Center, E Hospital. Patients weighing ≥15 kg who underwent totally endoscopic VSD closure using a 3D endoscopic system were included. Data collected included anthropometric and clinical characteristics, cardiopulmonary bypass (CPB) time, aortic cross-clamp time, perioperative complications, echocardiography before discharge, and early follow-up results.

Results: The overall mortality rate was 0%. Postoperative complications occurred in 4 patients (1 bleeding, 1 pleural hematoma, and 2 femoral artery stenoses), all successfully managed. One patient required reoperation for patch dehiscence, while 7 patients had small residual shunts not requiring further intervention. Compared with previous reports, CPB time was longer, but safety and clinical outcomes remained acceptable.

Conclusions: Totally endoscopic VSD closure without robotic assistance is a safe, effective, and feasible technique for patients ≥2 years of age and weighing ≥15 kg.