Totally endoscopic robotic ventricular septal defect repair in the adult

Objective: We have previously reported total endoscopic ventricular septal defect repair in the adult using the da Vinci S Surgical System. The optimal results encouraged us to extend the use of this technology to more complicated patients with ventricular septal defect. Methods: From January 2009 to July 2010, 20 patients underwent total endoscopic robotic ventricular septal defect repair. The average patient age was 29.0 +/- 9.5 years (range, 16-45). Of the 20 patients, 9 were female and 11 were male. The echocardiogram demonstrated that the average diameter of the ventricular septal defect was 6.1 +/- 2.8 mm (range, 2-15), and 4 patients had concomitant patent foramen ovale. Ventricular septal defect closure was directly secured with interrupted mattress sutures in 14 patients and patched in 6 patients. All the procedures were completed using the da Vinci robot by way of 3 port incisions and a 2.0- to 2.5-cm working port in the right side of the chest. Results: All patients were operated on successfully. The mean cardiopulmonary bypass and mean crossclamp time was 94.3 +/- 26.3 minutes (range, 70-140) and 39.1 +/- 12.9 minutes (range, 22-75), respectively. The mean operation time was 225.0 +/- 34.8 minutes (range, 180-300). The postoperative transesophageal echocardiogram demonstrated an intact ventricular septum. No residual left-to-right shunting and no permanently complete atrioventricular dissociation was found postoperatively. The mean hospital stay was 5 days. No residual shunt was found during a mean follow-up of 7 months (range, 1-22). The patients returned to normal function within 1 week without any complications. Conclusions: Total endoscopic robotic ventricular septal defect repair in adult patients is feasible, safe, and efficacious. (J Thorac Cardiovasc Surg 2012; 144:1404-7)