Totally endoscopic robotic atrial septal defect repair on the beating heart.

BACKGROUND: Atrial septal defect (ASD) repairs have successfully been performed on the arrested heart with the da Vinci S Surgical System (Intuitive Surgical). This study assessed the feasibility, safety, and efficacy of the use of the da Vinci S Surgical System for on-pump ASD repairs on the beating heart without cross-clamping the aorta.

METHODS: This prospective study included 24 consecutive patients who underwent ASD repair surgery between June 2008 and June 2009. All of the procedures were completed with the da Vinci S robot via 3 port incisions in the right chest and a 1.5-cm working port. The operations were carried out on the beating heart with mild hypothermic cardiopulmonary bypass (CPB) without cross-clamping the aorta. Venting the heart from the working port provided adequate visualization of the operative field.

RESULTS: All patients underwent complete repairs. Fourteen patients underwent ASD closure with a fresh autogenous pericardial patch, and 10 patients underwent direct ASD closure. Concomitant surgery was required in 4 patients. The mean (+/-SEM) CPB time was 65.6 +/- 17.7 minutes, and the mean operative time was 98.5 +/- 19.3 minutes. No patient required transfusion of red blood cells. The length of patient stay in the intensive care unit was 0.5 to 1.0 days. The length of hospital stay was 4 to 5 days. Follow-up transthoracic echocardiography evaluations showed no residual atrial septal leakage. There were no operative deaths, strokes, or other complications. All of the patients were discharged.

CONCLUSIONS: We have shown that use of the da Vinci S Surgical System to perform on-pump ASD repairs on the beating heart without cross-clamping the aorta is feasible, safe, and effective.