Robotic versus sternotomy approach for closure of atrial septal defect_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIU Can , ZHANG Chengxin , LIU Zhuang ,  GE Shenglin

Department of Cardiovascular Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, P.R.China;

Corresponding author：

GE Shenglin, Email: aydgsl@sina.com

Keywords：

Minimally invasive surgical procedures; robotic surgical procedures; heart septal defects, atrial

DOI：

10.7507/1007-4848.202012048

Video：

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Objective To compare the short-term outcomes of surgical repair for atrial septal defect (ASD) with a robotic (da Vinci Si) approach versus a conventional open procedure.Methods Clinical data of 140 patients undergoing ASD closure in the First Affiliated Hospital of Anhui Medical University from January 2016 to May 2020 were retrospectively analyzed. The patients were divided into a robotic group and a sternotomy group according to different surgical methods. In the robotic group, there were 67 patients including 20 males and 47 females at a median age of 40.0 (25.0) years, and in the sternotomy group there were 73 patients including 23 males and 50 females at a median age of 41.0 (29.0) years. Multivariate linear regressions were used to produce risk-adjusted analysis of pertinent clinical characteristics. Kaplan-Meier analysis was performed to compare the speed of sternotomy versus robotic group returning to exercise or daily life.Results Robotic-assisted surgery was associated with significantly shorter 24 h postoperative drainage volume [220.0 (210.0) mL vs. 345.0 (265.0) mL, P<0.001], mechanical ventilation [6.0 (11.0) h vs. 8.0 (11.0) h, P=0.024], intensive care unit length of stay (LOS) [19.0 (19.0) h vs. 22.0 (25.0) h, P=0.005], postoperative hospital LOS [9.0 (5.0) d vs. 10.0(6.0) d, P=0.003], and a lower rate of perioperative blood transfusion (28.36% vs. 84.93%, P<0.001). After controlling for patient comorbidity in the multiple regression model, there remained a trend toward decreased 24 h postoperative drainage volume (β=–115.30, 95%CI–170.78 to –59.82, P<0.001), mechanical ventilation (β=–4.96, 95%CI –8.33 to –1.59, P=0.004) and postoperative hospital LOS (β=–2.31, 95%CI –3.98 to –0.63, P=0.007) in the robotic group. Kaplan-Meier analysis revealed that patients returned to exercise or daily life earlier in the robotic group [35.0 (32.0) d vs. 90.0 (75.0) d, P<0.001].Conclusion Closure of ASD can be performed safely and effectively via robotic approach. And the minimally invasive technique is beneficial to postoperative recovery.

Citation： LIU Can, ZHANG Chengxin, LIU Zhuang, GE Shenglin. Robotic versus sternotomy approach for closure of atrial septal defect. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(5): 529-533. doi: 10.7507/1007-4848.202012048 Copy

1.	Bernier PL, Stefanescu A, Samoukovic G, et al. The challenge of congenital heart disease worldwide: Epidemiologic and demographic facts. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2010, 13(1): 26-34.
2.	Dolk H, Loane M, Garne E. Congenital heart defects in Europe: Prevalence and perinatal mortality, 2000 to 2005. Circulation, 2011, 123(8): 841-849.
3.	Baumgartner H, Bonhoeffer P, De Groot NM, et al. ESC Guidelines for the management of grown-up congenital heart disease (new version 2010). Eur Heart J, 2010, 31(23): 2915-2957.
4.	Vistarini N, Aiello M, Mattiucci G, et al. Port-access minimally invasive surgery for atrial septal defects: A 10-year single-center experience in 166 patients. J Thorac Cardiovasc Surg, 2010, 139(1): 139-145.
5.	Butera G, Biondi-Zoccai G, Sangiorgi G, et al. Percutaneous versus surgical closure of secundum atrial septal defects: A systematic review and meta-analysis of currently available clinical evidence. EuroIntervention, 2011, 7(3): 377-385.
6.	Modi P, Hassan A, Chitwood WJ. Minimally invasive mitral valve surgery: A systematic review and meta-analysis. Eur J Cardiothorac Surg, 2008, 34(5): 943-952.
7.	Morgan JA, Peacock JC, Kohmoto T, et al. Robotic techniques improve quality of life in patients undergoing atrial septal defect repair. Ann Thorac Surg, 2004, 77(4): 1328-1333.
8.	Xiao C, Gao C, Yang M, et al. Totally robotic atrial septal defect closure: 7-year single-institution experience and follow-up. Interact Cardiovasc Thorac Surg, 2014, 19(6): 933-937.
9.	Doulamis IP, Spartalis E, Machairas N, et al. The role of robotics in cardiac surgery: A systematic review. J Robot Surg, 2019, 13(1): 41-52.
10.	Stone GW, Maehara A, Lansky AJ, et al. A prospective natural-history study of coronary atherosclerosis. N Engl J Med, 2011, 364(3): 226-235.
11.	Zhe Z, Kun H, Xuezeng X, et al. Totally thoracoscopic versus open surgery for closure of atrial septal defect: Propensity-score matched comparison. Heart Surg Forum, 2014, 17(4): E227-E231.
12.	Senay S, Gullu AU, Kocyigit M, et al. Robotic atrial septal defect closure. Multimed Man Cardiothorac Surg, 2014, mmu014.
13.	Yang M, Yao M, Wang G, et al. Comparison of postoperative quality of life for patients who undergo atrial myxoma excision with robotically assisted versus conventional surgery. J Thorac Cardiovasc Surg, 2015, 150(1): 152-157.
14.	Torracca L, Ismeno G, Alfieri O. Totally endoscopic computer-enhanced atrial septal defect closure in six patients. Ann Thorac Surg, 2001, 72(4): 1354-1357.
15.	Bush B, Nifong LW, Chitwood WJ. Robotics in cardiac surgery: Past, present, and future. Rambam Maimonides Med J, 2013, 4(3): e17.
16.	Harky A, Hussain S. Robotic cardiac surgery: The future gold standard or an unnecessary extravagance? Braz J Cardiovasc Surg, 2019, 34(4): XII-XIII.
17.	Santana O, Reyna J, Grana R, et al. Outcomes of minimally invasive valve surgery versus standard sternotomy in obese patients undergoing isolated valve surgery. Ann Thorac Surg, 2011, 91(2): 406-410.
18.	Bonaros N, Schachner T, Oehlinger A, et al. Robotically assisted totally endoscopic atrial septal defect repair: Insights from operative times, learning curves, and clinical outcome. Ann Thorac Surg, 2006, 82(2): 687-693.

1. Bernier PL, Stefanescu A, Samoukovic G, et al. The challenge of congenital heart disease worldwide: Epidemiologic and demographic facts. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2010, 13(1): 26-34.
2. Dolk H, Loane M, Garne E. Congenital heart defects in Europe: Prevalence and perinatal mortality, 2000 to 2005. Circulation, 2011, 123(8): 841-849.
3. Baumgartner H, Bonhoeffer P, De Groot NM, et al. ESC Guidelines for the management of grown-up congenital heart disease (new version 2010). Eur Heart J, 2010, 31(23): 2915-2957.
4. Vistarini N, Aiello M, Mattiucci G, et al. Port-access minimally invasive surgery for atrial septal defects: A 10-year single-center experience in 166 patients. J Thorac Cardiovasc Surg, 2010, 139(1): 139-145.
5. Butera G, Biondi-Zoccai G, Sangiorgi G, et al. Percutaneous versus surgical closure of secundum atrial septal defects: A systematic review and meta-analysis of currently available clinical evidence. EuroIntervention, 2011, 7(3): 377-385.
6. Modi P, Hassan A, Chitwood WJ. Minimally invasive mitral valve surgery: A systematic review and meta-analysis. Eur J Cardiothorac Surg, 2008, 34(5): 943-952.
7. Morgan JA, Peacock JC, Kohmoto T, et al. Robotic techniques improve quality of life in patients undergoing atrial septal defect repair. Ann Thorac Surg, 2004, 77(4): 1328-1333.
8. Xiao C, Gao C, Yang M, et al. Totally robotic atrial septal defect closure: 7-year single-institution experience and follow-up. Interact Cardiovasc Thorac Surg, 2014, 19(6): 933-937.
9. Doulamis IP, Spartalis E, Machairas N, et al. The role of robotics in cardiac surgery: A systematic review. J Robot Surg, 2019, 13(1): 41-52.
10. Stone GW, Maehara A, Lansky AJ, et al. A prospective natural-history study of coronary atherosclerosis. N Engl J Med, 2011, 364(3): 226-235.
11. Zhe Z, Kun H, Xuezeng X, et al. Totally thoracoscopic versus open surgery for closure of atrial septal defect: Propensity-score matched comparison. Heart Surg Forum, 2014, 17(4): E227-E231.
12. Senay S, Gullu AU, Kocyigit M, et al. Robotic atrial septal defect closure. Multimed Man Cardiothorac Surg, 2014, mmu014.
13. Yang M, Yao M, Wang G, et al. Comparison of postoperative quality of life for patients who undergo atrial myxoma excision with robotically assisted versus conventional surgery. J Thorac Cardiovasc Surg, 2015, 150(1): 152-157.
14. Torracca L, Ismeno G, Alfieri O. Totally endoscopic computer-enhanced atrial septal defect closure in six patients. Ann Thorac Surg, 2001, 72(4): 1354-1357.
15. Bush B, Nifong LW, Chitwood WJ. Robotics in cardiac surgery: Past, present, and future. Rambam Maimonides Med J, 2013, 4(3): e17.
16. Harky A, Hussain S. Robotic cardiac surgery: The future gold standard or an unnecessary extravagance? Braz J Cardiovasc Surg, 2019, 34(4): XII-XIII.
17. Santana O, Reyna J, Grana R, et al. Outcomes of minimally invasive valve surgery versus standard sternotomy in obese patients undergoing isolated valve surgery. Ann Thorac Surg, 2011, 91(2): 406-410.
18. Bonaros N, Schachner T, Oehlinger A, et al. Robotically assisted totally endoscopic atrial septal defect repair: Insights from operative times, learning curves, and clinical outcome. Ann Thorac Surg, 2006, 82(2): 687-693.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Robotic versus sternotomy approach for closure of atrial septal defect

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