Totally thoracoscopic closure for atrial septal defect on perfused beating hearts

Abstract

Objectives: To investigate the feasibility and safety of non-robotically assisted totally thoracoscopic closure for atrial septal defect (ASD) on perfused beating hearts. Methods: Twenty-four patients (8-45 years, mean 14.4±18.7) underwent ASD closure on beating hearts by a totally thoracoscopic approach without the aid of a robotic surgical system. Additional 72 patients undergoing totally thoracoscopic ASD closure on cardioplegic arrested hearts were selected as a control. Cardiopulmonary bypass (CPB) was achieved peripherally. The aorta was not crossclamped in the study group but it was cross-clamped in the control group. Results: ASD closure was successful in all study and control group patients without in-hospital mortality or major complications. The total duration of operation (76±9 vs. 98±6 min, P = 0.012), CPB time (32±5 vs. 48±4 min, P=0.001), duration of intensive care stay (10.0±5.1 vs. 19.2±4.2 h, P=0.003) and post-operative hospital stay (4.5±0.8 vs. 5.0±1.1 days, P=0.045) in the study group were shorter than in the control group. There was no statistically significant difference in the proportion of patients requiring in-operation blood transfusion between study group and control group (25.0 vs. 36.1%, P=0.226). Follow-up transthoracic echocardiography on Day 5 and Day 30 showed no residual shunts in study or control group patients. Conclusions: Non-robotically assisted totally thoracoscopic closures of ASD on perfused beating hearts are feasible and safe. These procedures are associated with a shorter operation time and a shorter hospital stay than in surgeries on cardioplegic arrested hearts. © The Author 2011. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.