Totally Endoscopic Atrial-Septal Defect Repair through 3 Ports

Abstract

The standard techniques of laparoscopic surgery were first used in the late 1980s, and this method rapidly developed into a safe and effective procedure that became the standard of care. Cardiac surgery has been the last surgical specialty to completely embrace endoscopic techniques. Our working hypothesis was that atrial-septal defect (ASD) repairs can be performed by using a totally 2-dimensional endoscope view through 3 ports with results that are similar to those obtained with traditional surgical techniques. From May 2000 to May 2006, we performed totally endoscopic ASD repairs through 3 ports in 238 patients. Femorofemoral cardiopulmonary bypass and transthoracic clamp techniques were used. The operation was performed successfully in 234 patients (98%). In 4 patients the port was enlarged to a 5-cm incision. Neither conversion to median sternotomy incision nor reoperation was necessary in any patients. Mean operation time was 2.2 +/-0.8 hours; mean cardiopulmonary bypass and aortic cross-clamp times were 66 +/- 19 minutes and 25 +/- 8 minutes, respectively. No in-hospital deaths occurred. Major postoperative complications occurred in 13 patients (5%). Echocardiographic examinations performed at the time of discharge revealed no residue leaks. Mild mitral valve regurgitation was observed in 2 patients and mild tricuspid valve regurgitation in 4 patients. Patients reported satisfaction with cosmetic results and levels of postoperative discomfort. Totally endoscopic ASD repair through 3 ports is technically feasible and safe.