Total endoscopic repair of atrial septal defect under on-pump beating heart

Tang, Yihu; Wu, Yanhu; Zhu, Jie; Xiang, Liangzhong; Zhou, Ji; Huang, Haobing; Li, Mingke; Dai, Yawei; Han, Xu

doi:10.21037/jtd.2018.10.89

Cited by 6 publications

(15 citation statements)

References 16 publications

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“…Atrial septal defect (ASD) is the most common congenital heart disease (CHD) of adulthood [ 1 ], accounting for about 30–40% of adult CHD [ 2 , 3 ]. The 2008 ACC/AHA and 2010 ESC guidelines for the management of adult CHD recommended that atrial septal defect repair should be performed either surgically or percutaneously if right atrial and ventricular enlargement occur, regardless of symptoms [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

Total Thoracoscopic versus Robotic Surgery for Repair of Atrial Septum Defect: A Propensity Matching Score Analysis

Liu

et al. 2022

Emergency Medicine International

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Robotic surgery can provide less surgical trauma than conventional surgery, but differences between robotic and thoracoscopic surgery for atrial septal defect (ASD) repair are not well documented. To explore whether ASD can be repaired by thoracoscopic surgery or robotic surgery, which procedure is less invasive, and the difference in outcomes between these two procedures, this article studies 160 patients undergoing ASD repair at our institution. Sixty-five patients underwent total thoracoscopic surgery and 95 patients underwent total endoscopic robotic surgery. Propensity score matching yielded 64 well-matched patient pairs. Surgical data and early postoperative outcomes between the two matched groups were analyzed and compared. The results show that thoracoscopic and robotic surgery to repair ASD are both safe and reliable, and the early curative effect is good. However, regardless of similar complication rates, robotic surgery has a shorter time, less postoperative drainage, and faster recovery than thoracoscopic surgery.

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Section: Introductionmentioning

confidence: 99%

Total Thoracoscopic versus Robotic Surgery for Repair of Atrial Septum Defect: A Propensity Matching Score Analysis

Liu

et al. 2022

Emergency Medicine International

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“…14 This phenomenon is most often recorded in young women and small children, who often have small FAs associated with a strong spasm reflex of the vascular smooth muscle. 15 The weight limit was ≥13.5 kg, 7 ≥15 kg, 16 or >20 kg 17 depending on the studies.…”

Section: Discussionmentioning

confidence: 99%

Intermediate-Term Outcomes of Totally Endoscopic Atrial Septal Defect Repair on Beating Heart in Small Children

Nguyen¹,

Dang

Nguyen

et al. 2022

Innovations�(Phila)

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Objective: Manipulation in a narrow surgical field and risks of femoral arterial (FA) complications are difficulties when applying totally endoscopic surgery (TES) for congenital heart disease in small children. This study was conducted to investigate the feasibility of TES for atrial septal defect (ASD) repair in children weighing 13 to 20 kg. Methods: From July 2016 to July 2021, 14 patients with a mean age of 5.4 ± 2.2 years and mean weight of 15.57 ± 2.39 kg (range, 13 to 20 kg), underwent TES for ASD repair on the beating heart. FA cannulation was established through a Dacron graft. An additional FA cannula (2 to 4 Fr smaller than the expected size) was placed into the left FA in case of increasing arterial pressure. Three 5 or 5.5 mm trocars and one 12 mm port were used. The surgical field was filled with CO2. No aortic clamp, no aortic root needle, and no snaring of the inferior vena cava were used. The mean follow-up time was 37.9 ± 12.5 months. Results: Cardiopulmonary bypass (CPB) installation time, CPB time, and operation time were 42.6 ± 16.5 min, 113.1 ± 33.1 min, and 209.6 ± 50.6 min, respectively. Total drainage volume was 125.4 ± 89.2 mL. Patients did not need analgesics on day 4 or 5 after surgery. No severe complications, including arterial complications, were recorded during follow-up. Conclusions: By optimizing the surgical field and setting the FA cannula correctly, TES for ASD closure is feasible in small children weighing between 13 and 20 kg.

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“…However, these previous studies were on adult VSD patients, and they did not compare the effect of the two techniques on postoperative ICU stay, length of hospital stay, inpatient complications, and shortterm and medium-term outcomes. In this context, Tang et al compared the on beating heart and cardioplegic techniques in the repair of atrial septal defects (ASDs) and found that the durations of surgery, CPB, aortic cross-clamp, mechanical ventilation, ICU stay, and postoperative hospital stay were all markedly shorter in the on beating heart group (P<0.05) and no severe complications occurred (21).…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have also suggested that repairing a VSD on a beating heart is an effective strategy for avoiding CAVB (12,16). Air embolism remains a significant concern in the repair of septal defects on a beating heart (10); however, previous studies have reported that opening the beating left ventricle does not necessarily increase the risk of air embolism (12,21,25). In light of this evidence, routine measures were applied in the present study to prevent air intake to the left ventricle, and continuous monitoring of TEE showed no significant air volume in the left ventricle.…”

Section: Discussionmentioning

confidence: 99%

Revising ventricular septal defect residual shunts without aortic re-cross-clamping: a safe and effective surgical procedure

Cao¹,

Chai²,

Liu³

et al. 2020

Ann Transl Med

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Background: The conventional approach to revising a residual shunt following ventricular septal defect (VSD) closure is to re-occlude the aorta and repair the residual shunt under cardioplegic arrest. The present study evaluated the safety and effectiveness of a new approach for revising residual shunts following VSD repair without re-occluding the aorta. This approach is known as on beating heart surgery.Methods: This retrospective study included 80 pediatric patients who underwent surgical closure of a simple VSD. Residual shunts larger than 2 mm were intraoperatively detected by transesophageal echocardiography (TEE) and these patients received immediate reintervention. Of the patients, 37 received on beating heart surgery without aortic cross-clamping (Group A) and 43 patients were operated on with aortic cross-clamping and cardioplegia (Group B).Results: Residual VSD closures were successfully performed in all patients. Group A had significantly shorter aortic cross-clamp times (P<0.0001), significantly shorter CPB times (P<0.01), a lower incidence of prolonged ventilation (>6 hours) (P=0.04), a lower incidence of prolonged intensive care unit (ICU) stay (ICU stay >1 day) (P=0.02), and reduced in-hospital expenses (P<0.0001) compared with Group B. There was no significant difference in the incidence of recurrent residual shunts (P=0.96), prolonged postoperative hospital stay (>5 days) (P=0.24), or the incidence of perioperative complications (P=0.81) between the groups.Conclusions: On beating heart surgery is a safe and effective approach for the closure of residual VSDs and is significantly associated with a lower incidence of prolonged ventilation, a lower incidence of prolonged ICU stay, and reduced in-hospital expenses.

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Total endoscopic repair of atrial septal defect under on-pump beating heart

Cited by 6 publications

References 16 publications

Total Thoracoscopic versus Robotic Surgery for Repair of Atrial Septum Defect: A Propensity Matching Score Analysis

Total Thoracoscopic versus Robotic Surgery for Repair of Atrial Septum Defect: A Propensity Matching Score Analysis

Intermediate-Term Outcomes of Totally Endoscopic Atrial Septal Defect Repair on Beating Heart in Small Children

Revising ventricular septal defect residual shunts without aortic re-cross-clamping: a safe and effective surgical procedure

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