Kim Kitae, Kim Yun Seok, Kim Hong Rae, Kim Ho Jin, Yoo Jae Suk, Kim Joon Bum, Jung Sung-Ho, Lee Jae Won
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Department of Thoracic and Cardiovascular Surgery, Keimyung Medical Center, University of Keimyung College of Medicine, Daegu, South Korea.
JTCVS Tech. 2024 Jun 10;28:73-81. doi: 10.1016/j.xjtc.2024.05.022. eCollection 2024 Dec.
Minimally invasive repair using robotic systems has been accepted as an attractive alternative in the surgical repair of atrial septal defects (ASDs). Clear exposure of the entire rim of the ASD is often hindered during a robotic approach. Here, we describe an approach using vertical right atriotomy along the interatrial groove that may enhance the exposure of the ASD.
Patients who underwent ASD closure using the da Vinci Si surgical ystem (Intuitive Surgical) from 2007 to 2021 were included. During ASD closure procedures, right atriotomy was performed either conventionally in an oblique manner or parallel to the interatrial groove. A comparative analysis was performed in terms of all-cause mortality, complications, and durations of cardiopulmonary bypass, aortic crossclamp, intensive care unit stay, and hospital stay. The inverse probability of treatment weighting was utilized to balance baseline characteristics across different surgical approaches.
A total of 114 consecutive patients (mean age, 38.7 ± 12.8 years) constituted the study cohort. There were no cases of mortality or surgical complications in either group. After adjusting for potential covariates, the cardiopulmonary bypass (92.8 ± 31.5 minutes vs 143.1 ± 40.7 minutes) and aortic crossclamp (30.7 ± 21.3 minutes vs 60.8 ± 23.5 minutes) times were significantly shorter in the group using vertical right atriotomy than in the group using conventional approach ( < .001 for both).
Performing vertical right atriotomy adjacent to the interatrial groove optimized ASD exposure compared with the conventional approach during robotic ASD repair, leading to reduced cardiopulmonary bypass and aortic crossclamp times.
使用机器人系统进行微创修复已被视为房间隔缺损（ASD）手术修复中一种有吸引力的替代方法。在机器人手术过程中，ASD整个边缘的清晰暴露常常受到阻碍。在此，我们描述一种沿房间沟进行右心房垂直切开的方法，该方法可能会增强ASD的暴露。
纳入2007年至2021年期间使用达芬奇Si手术系统（直观外科公司）进行ASD封堵的患者。在ASD封堵手术过程中，右心房切开术要么以传统的斜向方式进行，要么与房间沟平行。对全因死亡率、并发症以及体外循环、主动脉阻断、重症监护病房停留时间和住院时间进行了比较分析。采用治疗权重的逆概率来平衡不同手术方法的基线特征。
共有114例连续患者（平均年龄38.7±12.8岁）构成研究队列。两组均无死亡或手术并发症病例。在调整潜在协变量后，采用右心房垂直切开术的组的体外循环时间（92.8±31.5分钟对143.1±40.7分钟）和主动脉阻断时间（30.7±21.3分钟对60.8±23.5分钟）明显短于采用传统方法的组（两者均P<0.001）。
在机器人ASD修复过程中，与传统方法相比，在房间沟附近进行右心房垂直切开可优化ASD暴露，从而缩短体外循环和主动脉阻断时间。
