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

Abstract

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.

Totally Endoscopic Surgery for Repairing Sinus Venosus Atrial Septal Defect Using Double-Patch Technique on Beating Heart

“…In ASD repair, a beating heart with pleural and pericardial cavities filled with CO 2 has many advantages, including (1) safety, (2) time savings and limited bleeding due to no touch on the ascending aorta, and (3) a more extensive surgical field. 15–17 Through this study, we found that the absence of a transthoracic clamp allowed the SVC and related structures to be observed more clearly. In addition, the surgical steps on the SVC, including the SVC snaring, the first patch, and the second patch, could be done quickly with average times of 8.8 ± 3.4 min, 25.0 ± 9.6 min, and 25.9 ± 9.0 min, respectively (Table 4).…”

Totally Endoscopic Atrial Septal Defect Repair on Beating Heart: Clinical Outcome and Single-Surgeon Learning Curve Experience

“…The rate of bilateral FA cannulation in this study was 26.8%, significantly lower than that of 71.4% in patients weighing <20 kg with the same CPB cannulation method. 8 We suggest that the immature vasoconstriction reflex may be the reason for this phenomenon.…”

“…10 TES in small patients with body weight <20 kg has more difficulties than the other group of patients, including (1) the risk of postoperative femoral arterial stenosis or obstruction and (2) the narrow surgical field making manipulation difficult. 8,12 However, TES for ASD repair without robotic assistance has not been widely applied, even in patients weighing ≥20 kg. Most published studies come from China, with a procedure similar to the traditional approach.…”

“…ASD repair on the beating heart has the advantages of (1) significantly reducing the risk of bleeding due to no touch on the aortic root, (2) shortening the CPB time, and (3) simplifying the procedure. 8,9,12,19 The more straightforward the procedure, the shorter the training curve and the higher the applicability. Ma et al and Tang et al snared the IVC when applying TES for ASD repair on beating heart.…”

“…Totally endoscopic surgery (TES) without robotic assistance is a good option for patients who are unsuitable for intervention. 3,4 Although TES has been successfully applied to correct some problematic cases of ASD, including ASD with anomalous pulmonary vein (APV) connection, 5 sinus venosus ASD, 6 ASD with interrupted inferior vena cava (IVC), 7 and ASD in small children weighing <20 kg, 8 TES for ASD repair without robotic assistance has not been widely applied, even in patients weighing ≥20 kg. Until now, most reports on this technique have come from Chinese authors with the same technique process.…”