Minimally invasive endoscopic surgery versus catheter-based device occlusion for atrial septal defects in adults: reconsideration of the standard of care

Schneeberger, Y.; Schaefer, Andreas; Conradi, Lenard; Brickwedel, J.; Reichenspurner, Hermann; Kozlik‐Feldmann, Rainer; Detter, Christian

doi:10.1093/icvts/ivw366

Cited by 9 publications

(16 citation statements)

References 22 publications

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“…The feasibility of repair in all ASD types is another advantage of the robotic surgery 9,11–13 . In the literature, many studies have reported the safety and efficacy of transcatheter ASD closure and similar outcomes when compared with surgical ASD closures including minimally invasive surgery through mini‐thoracotomy incision 14–16 However, there has been no report comparing transcatheter ASD closure with totally endoscopic robotic surgery. With the extensive use of robotic ASD closure in the current era, it is paramount to compare the effectiveness of robotic surgery with a transcatheter approach.…”

Section: Introductionmentioning

confidence: 99%

Transcatheter closure vs totally endoscopic robotic surgery for atrial septal defect closure: A single‐center experience

et al. 2020

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Background: Transcatheter closure is the preferred method for atrial septal defect (ASD) closure. Robotic surgery has become the least invasive technique for ASD closure. Therefore, we sought to evaluate the outcomes in patients who underwent ASD closure with transcatheter or robotic surgery techniques.Methods: A total of 462 patients underwent totally endoscopic robotic (n = 217) or transcatheter ASD closure (n = 245). Demographic data, perioperative data, and outcomes were compared.Results: The mean age was lower in the robotic surgery group than the transcatheter group (31.4 ± 11.8 vs 39.4 ± 13.2 years; P = .001). Ventilation time, intensive care unit (ICU) stay, and hospital stay was significantly lower in the transcatheter group. The postoperative new-onset neurological event was seen in one (0.5%) patient in robotic surgery, and four (1.6%) patients in the transcatheter closure group.New-onset atrial fibrillation was found to be higher in transcatheter closure (two vs seven patients; P = .133) group. Surgical conversion to a larger incision occurred in two patients (1%) in robotic surgery, while two patients (0.5%) underwent emergency median sternotomy due to device embolization to the main pulmonary artery.There was no mortality in both groups. During follow-up, one patient (0.5%) who underwent robotic surgery was reoperated, and two patients (0.8%) who underwent transcatheter procedure required surgical intervention due to device migration and severe residual shunting (P = .635).Conclusion: Both transcatheter and robotic surgery approaches had excellent outcomes but transcatheter closure had shorter hospital and ICU stays. Robotic surgery provides a similar complication risk that can be comparable to the transcatheter approach as well as patient comfort and cosmetic advantage over the other surgical techniques. K E Y W O R D Satrial septal defect, minimally invasive, robotic surgery, transcatheter

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Section: Introductionmentioning

confidence: 99%

Transcatheter closure vs totally endoscopic robotic surgery for atrial septal defect closure: A single‐center experience

et al. 2020

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“…Minimally invasive cardiac surgery (MICS), through “mini-sternotomy” or video assisted thoracoscopic surgery (VATS) (with or without robotic assistance), has the potential to reduce procedural morbidity relative to open heart surgery with reductions in length of stay along with improved cosmesis compared to conventional surgical correction of ASD[54]. However, to date the largest case series of MICS report lengths of stay (median between 5–7 days) that are similar to conventional studier and much longer than that following TC-ASD (1 day or less) [55–58]. Enthusiasm and expertise in MICS remains limited to a few centers and is not yet a compelling alternative to conventional O-ASD and TC-ASD.…”

Section: Minimally Invasive Cardiac Surgerymentioning

confidence: 99%

State-of-the-Art Atrial Septal Defect Closure Devices for Congenital Heart

O’Byrne

Levi

2019

Interventional Cardiology Clinics

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The purpose of this review is to describe the current state of the art in terms of available devices and indications for the transcatheter device closure of atrial septal defects (ASD) and patent foramen ovale (PFO) in children and young adults. Techniques for transcatheter device closure of ASD (TC-ASD) are well established and TC-ASD has a proven track record of efficacy and safety. Device erosion, a rare but potentially catastrophic adverse event of TC-ASD has raised questions about the relative safety of TC-ASD versus operative open heart surgical ASD closure (O-ASD). Despite a concerted effort to study the issue, there are no solutions that avoid the risk of erosions definitively when using the Amplatzer device. There is evidence that concern about erosions has changed practice in the United States, specifically that more patients are referred for O-ASD than in the past. Efforts to study these changes have also revealed more variation in TC-ASD practice than previously appreciated. New devices for ASD closure with properties that may reduce the risk of erosion are being developed and brought to market, but, in the meantime, cardiologists must continue to balance the risks and benefits of TC- and O-ASD closure. Recent studies demonstrating the superiority of PFO device closure over medical therapy for cryptogenic stroke is likely to lead to changes in practice for structural/interventional cardiologists. Previously, the overwhelming majority of ASD closure procedures were performed for right heart volume overload due to left to right shunt, but stroke prophylaxis may become a more significant part of the volume in pediatric/congenital catheterization laboratories. Care should be taken in extrapolating this data to children and younger adults, and important questions about patient selection remain unresolved.

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“…Jugular cannulation can also be used in minimally invasive cardiac surgery. 16,18 We performed a minimally invasive ASD repair from right mini thoracotomy through a 3-cm incision in a pediatric patient using jugular vessel cannulation. It is a quick and safe method for institution of CPB and creates more space for the operation field.…”

Section: Commentmentioning

confidence: 99%

Utility of Cervical Cannulation During Difficult Resternotomy in Congenital Heart Surgery

Temur

Davutoglu

Doğruöz

et al. 2019

World J Pediatr Congenit Heart Surg

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Background: Adhesions due to previous surgeries and some anatomical difficulties may make resternotomy dangerous in children. Femoral vessels are usually small and may not be suitable for cannulation. The aim of this report is to describe our experience with cervical cannulation during risky resternotomy in children. Methods: Between January 2014 and January 2018, cervical cannulation was performed in eight pediatric patients during sternal reentry. Their ages were between 3 months and 17 years (mean: 5.4 years). Three patients underwent stage III extracardiac Fontan operation with the diagnosis of hypoplastic left heart syndrome. Three patients had supravalvular aortic and/or pulmonary stenosis after previous arterial switch operation. One patient had proximal aortic arch stenosis and subvalvular aortic stenosis after interrupted aortic arch repair. The last patient had aortic root pseudoaneurysm and aortic insufficiency due to endocarditis. Through a separate cervical incision, a polytetrafluoroethylene graft was anastomosed to the common carotid artery and the arterial cannula was inserted into the graft. Antegrade selective cerebral perfusion (ASCP) was used in two patients. Results: During resternotomies, no major injury or bleeding occurred. Three-month-old patient who had previous interrupted aortic arch repair died despite extracorporeal membrane oxygenation support due to sepsis and multi-organ failure. Median intensive care unit stay and hospital stay were 3 days (1-40 days) and 17 days (7-60 days), respectively. Mean follow-up was 17.9 ± 15.8 months. All patients were in good clinical condition. Conclusions: Cervical cannulation may be a useful and safe technique during high-risk resternotomy in children. This technique may also simplify the performance of ASCP if necessary.

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Minimally invasive endoscopic surgery versus catheter-based device occlusion for atrial septal defects in adults: reconsideration of the standard of care

Cited by 9 publications

References 22 publications

Transcatheter closure vs totally endoscopic robotic surgery for atrial septal defect closure: A single‐center experience

Transcatheter closure vs totally endoscopic robotic surgery for atrial septal defect closure: A single‐center experience

State-of-the-Art Atrial Septal Defect Closure Devices for Congenital Heart

Utility of Cervical Cannulation During Difficult Resternotomy in Congenital Heart Surgery

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