Yang Ming, Gao Chang-qing, Xiao Cang-song, Wang Gang, Wang Jia-li, Wu Yang
Department of Cardiovascular Surgery, PLA General Hospital, Beijing, China.
Zhonghua Yi Xue Za Zhi. 2012 Aug 28;92(32):2261-4.
To summarize the clinical experiences on correction of congenital heart disease with robotic technology at a single center.
Between January 2007 and May 2012, this retrospective study recruited 160 consecutive patients undergoing robotic surgery for congenital heart diseases. There were 74 males and 86 females with a median age of 35 years (range: 11-62). The procedures included secundum-type atrial septal defect repair (n = 130), ostium primum defect repair (n = 1), perimembranous ventricular septal defect repair (n = 21), mitral valve repair for anterior leaflet cleft (n = 7) and mitral valve repair plus left atrial myxoma resection (n = 1). Cardiopulmonary bypass graft was established through cannulation of right femoral artery, vein and right internal jugular vein under the guidance of transesophageal ultrasound. Myocardial protection was performed with cold blood cardioplegic solution or HTK solution and a transthoracic Chitwood clamp was used to occlude ascending aorta. Via three 8-mm ports and one 15-mm port in right chest, the microscopic instruments were manipulated to complete defect closure or mitral valve plasty, utilizing da Vinci S or da Vinci SI robotic system. Echocardiography was performed intraoperatively and at pre-discharge. Routine follow-ups were conducted. The clinical data of operating time, cardiopulmonary bypass time and follow-up examinations were retrospectively analyzed.
All cases were treated successfully without a conversion into median sternotomy. No operative mortality or severe surgical complications were observed. Seventy-six cases of secundum-type atrial septal defect were completed on beating heart. The learning curves were noted for operating time of beating heart group and cross clamp time of arrest heart group. No residual shunt, malignant arrhythmia or mitral valve regurgitation was detected on intraoperative or postoperative echocardiography and during a median follow-up period of (29.1 ± 16.3) months.
Robotic minimal access is technically feasible and it may be applied in selective patients with atrial septal defect, perimembranous ventricular septal defect and mitral valve cleft.
总结单中心应用机器人技术矫正先天性心脏病的临床经验。
2007年1月至2012年5月，本回顾性研究纳入了160例连续接受先天性心脏病机器人手术的患者。其中男性74例，女性86例，中位年龄35岁（范围：11 - 62岁）。手术包括继发孔型房间隔缺损修补术（n = 130）、原发孔缺损修补术（n = 1）、膜周部室间隔缺损修补术（n = 21）、二尖瓣前叶裂修补术（n = 7）以及二尖瓣修补术加左心房黏液瘤切除术（n = 1）。在经食管超声引导下，通过右股动脉、静脉及右颈内静脉插管建立体外循环通路。采用冷血心脏停搏液或HTK液进行心肌保护，使用经胸奇伍德钳夹闭升主动脉。经右胸三个8毫米端口和一个15毫米端口，操作显微器械，利用达芬奇S或达芬奇SI机器人系统完成缺损闭合或二尖瓣成形术。术中及出院前进行超声心动图检查。进行常规随访。对手术时间、体外循环时间及随访检查的临床资料进行回顾性分析。
所有病例均成功治疗，无一例转为正中开胸手术。未观察到手术死亡或严重手术并发症。76例继发孔型房间隔缺损在心脏跳动下完成手术。观察到心脏跳动组手术时间和心脏停搏组阻断钳夹时间的学习曲线。术中及术后超声心动图检查以及中位随访期（29.1 ± 16.3）个月期间，未检测到残余分流、恶性心律失常或二尖瓣反流。
机器人微创技术在技术上是可行的，可应用于选择性的房间隔缺损、膜周部室间隔缺损及二尖瓣裂患者。
