Multicenter study to assess learning curve and clinical outcome of totally endoscopic surgery for atrial septal defect repair without robotic assistance

Dang Quang Huy , Nguyen Cong Huu , Nguyen Minh Ngoc , Le Ngoc Thanh

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Abstract

125 patients (89 female patients; average age, 31.6 ± 18.7 years; age range, 3–72 years) with secundum-type ASDs were selected for this study. Three 5-mm trocars and one 12-mm trocar were used;  only  the  superior  vena  cava  was snared. The pleural and pericardial cavities were filled with CO2. All ASDs were closed using artificial patch, continuous suture; tricuspid valve regurgitations (TVR) were repaired and the anomalous pulmonary veins were drained to the left atrium. Surgeries were performed by one surgeon on the beating heart. No major complications or deaths occurred. No residual shunt was detected. Patients were divided into three groups: group I (without tricuspid valve repair), group II (DeVega), and group III (Ring annuloplasty). There were significant learning curves for the operation time and CPB time in  each group. In without tricuspid valve repair group, operation time and CPB time were: y = 400 – 52 ln(x) (r2 = 0.616) and y = 293 – 51 ln(x) (r2 = 0.852), respectively. In DeVega group, operation time and CPB time were: y = 271 – 29 ln(x) (r2  = 0.236) and y = 178 – 34 ln(x) (r2  = 0.659), respectively. In Ring annuloplasty group, operation time and CPB time were: y = 318 – 44 ln(x) (r2  = 0.565) and y = 184 – 29 ln(x) (r2  = 0.685), respectively. The length of stay in the intensive care unit was 25,3 ± 20,7 hours. Patients were discharged from the hospital 8 days after the operation.

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References

1. Bonaros, N., et al., Robotically assisted totally endoscopic atrial septal defect repair: insights from operative times, learning curves, and clinical outcome. Ann Thorac Surg, 2006. 82(2): p. 687-93.
2. Morgan, J.A., et al., Robotic techniques improve quality of life in patients undergoing atrial septal defect repair. Ann Thorac Surg, 2004. 77(4): p. 1328-33.
3. Senay, S., et al., Robotic atrial septal defect closure. Multimed Man Cardiothorac Surg, 2014. 2014.
4. Xiao, C., et al., Totally robotic atrial septal defect closure: 7-year single-institution experience and follow-up. Interact Cardiovasc Thorac Surg, 2014. 19(6): p. 933-7.
5. Ma, Z.S., et al., Totally thoracoscopic closure for atrial septal defect on perfused beating hearts. Eur J Cardiothorac Surg, 2012. 41(6): p. 1316-9.
6. Dang, Q.-H., et al., Totally Endoscopic Cardiac Surgery for Atrial Septal Defect Repair on Beating Heart Without Robotic Assistance in 25 Patients. Innovations:Technology and Techniques in Cardiothoracic and Vascular Surgery, 2017. 12(6): p. 446–452.
7. Liu, G., et al., Totally thoracoscopic surgical treatment for atrial septal defect: mid- term follow-up results in 45 consecutive patients. Heart Lung Circ, 2013. 22(2): p. 88-91.
8. Van der Linde, D., et al., Birth prevalence of congenital heart disease worldwide: a systematic review and meta-analysis. J Am Coll Cardiol, 2011. 58(21): p. 2241-7.
9. Carpentier, A., et al., [Computer assisted open heart surgery. First case operated on with success]. C R Acad Sci III, 1998. 321(5): p. 437-42.
10. Warinsirikul, W., et al., Closure of atrial septal defects without cardiopulmonary bypass: The sandwich operation. The Journal of Thoracic and Cardiovascular Surgery, 2001. 121(6): p. 1122-1129.
11. Ma, Z.S., et al., Totally thoracoscopic repair of atrial septal defect without robotic assistance: a single-center experience. J Thorac Cardiovasc Surg, 2011. 141(6): p. 1380-3.
12. Wang, F., et al., Totally thoracoscopic surgical closure of atrial septal defect in small children. Ann Thorac Surg, 2011. 92(1): p. 200-3.
13. Đặng Quang Huy, Nguyễn Ngọc Anh, and Lê Ngọc Thành, Phẫu thuật nội soi toàn bộ tim đập vá thông liên nhĩ ở bệnh nhân nữ 11 tuổi. Tạp chí phẫu thuật tim mạch và lồng ngực Việt Nam, 2016. 15: p. 28-32.
14. Đặng Quang Huy, et al., Phẫu thuật nội soi toàn bộ không có robot hỗ trợ, tim đập vá thông liên nhĩ ở 13 bệnh nhân. Tạp chí phẫu thuật tim mạch và lồng ngực Việt Nam, 2016. 15: p. 3-9.
15. Huy, Đ.Q., Phẫu thuật nội soi toàn bộ, không robot hỗ trợ, tim đập vá thông liên nhĩ ở trẻ nhỏ. Tạp chí phẫu thuật tim mạch và lồng ngực Việt Nam, 2017. 17.
16. Huy, Đ.Q., Phẫu thuật nội soi toàn bộ không có robot hỗ trợ, tim đập vá thông liên nhĩ. Kinh nghiệm ở một trung tâm. Tạp chí phẫu thuật tim mạch và lồng ngực Việt Nam, 2017. 18.
17. Rosu, C., et al., Preoperative vascular imaging for predicting intraoperative modification of peripheral arterial cannulation during minimally invasive mitral valve surgery. Innovations (Phila), 2015. 10(1): p. 39-43.
18. Sagbas, E., et al., Mid-term results of peripheric cannulation after port-access surgery. Interact Cardiovasc Thorac Surg, 2007. 6(6): p. 744-7.
19. Dang, H.Q., H.T. Le, and L.T.H. Ngo, Totally endoscopic atrial septal defect repair using transthoracic aortic cannulation in a 10.5- kg-boy. International journal of surgery case reports, 2018. 52: p. 103-106.
20. Thapmongkol, S., et al., Beating heart as an alternative for closure of secundum atrial septal defect. Asian Cardiovasc Thorac Ann, 2012. 20(2): p. 141-5.
21. Pendse, N., et al., Repair of atrial septal defects on the perfused beating heart. Tex Heart Inst J, 2009. 36(5): p. 425-7.
22. Cheng, Y., et al., Totally endoscopic congenital heart surgery compared with the traditional heart operation in children. Wien Klin Wochenschr, 2013. 125(21-22): p. 704-8.
23. Chaudhuri, K., et al., Carbon dioxide insufflation in open-chamber cardiac surgery: a double-blind, randomized clinical trial of neurocognitive effects. J Thorac Cardiovasc Surg, 2012. 144(3): p. 646-653 e1.
24. Gatzoulis, M.A., et al., Atrial arrhythmia after surgical closure of atrial septal defects in adults. N Engl J Med, 1999. 340(11): p. 839-46.
25. Berger, F., et al., Incidence of atrial flutter/fibrillation in adults with atrial septal defect before and after surgery. Ann Thorac Surg, 1999. 68(1): p. 75-8.
26. Berger, F., et al., Arrhythmias in patients with surgically treated atrial septal defects. Swiss Med Wkly, 2005. 135(11-12): p. 175-8.
27. Nyboe, C., et al., Atrial fibrillation and stroke in adult patients with atrial septal defect and the long-term effect of closure. Heart, 2015. 101(9): p. 706-11.
28. Mavroudis, C., B.J. Deal, and C.L. Backer, Surgery for arrhythmias in children. Int J Cardiol, 2004. 97 Suppl 1: p. 39-51.
29. Stulak, J.M., et al., Right-sided Maze procedure for atrial tachyarrhythmias in congenital heart disease. Ann Thorac Surg, 2006. 81(5): p. 1780-4; discussion 1784-5.
30. Yao, D.K., et al., Totally endoscopic atrial septal repair with or without robotic assistance: a systematic review and meta- analysis of case series. Heart Lung Circ, 2013. 22(6): p. 433-40.