Arkhipov A N, Bogachev-Prokofiev A V, Zubritskiy A V, Khapaev T S, Gorbatykh Yu N, Pavlushin P M, Karaskov A M
Meshalkin National Medical Research Center of Healthcare Ministry of the Russian Federation, Novosibirsk, Russia.
Khirurgiia (Mosk). 2018(2):4-20. doi: 10.17116/hirurgia201824-20.
To analyze immediate results of minimally invasive robot-assisted atrial septal defect (ASD) closure in adults.
For the period from March 2012 to November 2016 sixty patients with contraindications to endovascular procedure have undergone robot-assisted atrial septal defect closure at Meshalkin Siberian Federal Biomedical Research Center. Mean age was 34.5±11.3 years, body mass index - 24.6±4.0 kg/m. 48 (80%) patients had NYHA class II before surgery. In 37 (61.7%) patients isolated ASD with deficiency or absence of one edge was diagnosed, isolated ASD with primary septum aneurysm - in 16 (26.7%) cases, 7 (11.6%) patients had reticulate ASD. 5 (8.3%) patients had concomitant tricuspid valve insufficiency required surgical repair (suture annuloplasty). All operations were performed under cardiopulmonary bypass with peripheral cannulation. Right-sided anterolateral mini-thoracotomy was used in the first 43 patients. Following 17 patients underwent completely endoscopic procedure. Depending on the shape, size and anatomical features of the defect we performed suturing (14 patients, 23.3%) or repair with xenopericardial patch (46%, 76.6%).
Mean CPB and aortic cross-clamping time was 89.1±28.7 and 24.8±9.5 min, respectively. Postoperative variables: mechanical ventilation 3.3±1.5 hours, ICU-stay - 18.2±3.7 hours, postoperative hospital-stay - 13.4±5.7 days. There were no mortality and any life-threatening intra- and postoperative complications. Cases of conversion to thoraco-/sternotomy and postoperative bleeding followed by redo surgery were also absent. 23 patients were followed-up within 1 year, 6 patients - within 2 years, 3 patients - within 3 years. All patients were in NYHA class I-II with 100% freedom from ASD recanalization and redo surgery. According to echocardiography data there were decreased right heart, pulmonary artery pressure and preserved left ventricular function in early postoperative period and 1 year after surgery.
In view of favorable course of postoperative period, no significant specific complications and encouraging immediate results we can talk about endoscopic robot-assisted ASD closure in adults as a safe and effective alternative to surgical treatment.
分析成人微创机器人辅助房间隔缺损（ASD）封堵术的近期效果。
2012年3月至2016年11月期间，60例有血管内介入治疗禁忌证的患者在梅沙尔金西伯利亚联邦生物医学研究中心接受了机器人辅助房间隔缺损封堵术。平均年龄为34.5±11.3岁，体重指数为24.6±4.0kg/m²。48例（80%）患者术前纽约心脏协会（NYHA）心功能分级为Ⅱ级。37例（61.7%）患者诊断为孤立性ASD伴一侧边缘缺失或不足，16例（26.7%）患者诊断为孤立性ASD伴原发隔动脉瘤，7例（11.6%）患者为网状ASD。5例（8.3%）患者合并三尖瓣关闭不全需要手术修复（瓣环成形术缝合）。所有手术均在体外循环下采用外周插管进行。前43例患者采用右侧前外侧小切口开胸手术。后17例患者采用完全内镜手术。根据缺损的形状、大小和解剖特点，我们进行了缝合（14例，23.3%）或用异种心包补片修补（46例，76.6%）。
平均体外循环时间和主动脉阻断时间分别为89.1±28.7分钟和24.8±9.5分钟。术后指标：机械通气3.3±1.5小时，重症监护病房（ICU）停留时间为18.2±3.7小时，术后住院时间为13.4±5.7天。无死亡病例及任何危及生命的术中及术后并发症。也没有转为开胸/胸骨切开术及术后出血后再次手术的病例。23例患者随访1年，6例随访2年，3例随访3年。所有患者NYHA心功能分级为Ⅰ-Ⅱ级，ASD再通和再次手术的发生率为0%。根据超声心动图数据，术后早期及术后1年右心、肺动脉压力降低而左心室功能保留。
鉴于术后病程良好，无明显特殊并发症且近期效果令人鼓舞，我们可以认为成人内镜机器人辅助ASD封堵术是一种安全有效的手术治疗替代方法。
