[Perfusion strategies of extracorporeal circulation for robotically assisted cardiac surgery]

To discuss the management of extracorporeal circulation (ECC) for robotically assisted cardiac surgery.

A total of 71 patients underwent cardiac surgeries using da Vinci S robotic surgical system, including 49 undergoing atrial septal defect repair (ASDR), 13 undergoing mitral valvuloplasty (MVP), 8 receiving left atrial myxoma excision and 1 having right atrial myxoma excision. For most of the patients, ECC was established through the femoral arterial cannula, femoral venous cannula and right internal jugular venous cannula, with only 1 patient undergoing MVP with femorai arterial cannula and femoral venous cannula. In all the cases, vacuum-assisted venous drainage (VAVD), continuous blood gas monitoring and ultrafiltration were used during ECC. Myocardial protection was managed with 4:1 blood cardioplegic solution (61 cases) or HTK solution (10 cases receiving MVP).

The mean ECC time and aortic cross-clamp time was 116.1-/+35.5 min (range 45-206 min) and 58.5-/+23.6 min (range 27-132 min) in these patients, respectively. During ECC, the mean urine volume was 825.5-/+447.3 ml (200-1900 ml) and ultrafiltration volume was 2571.1-/+885.9 ml (800-4800 ml) with subzero-balanced (58 cases) or zero-balanced (9 cases) total fluid balance. The mean postoperative intubation time was 10.1-/+5.3 h (7-17 h) and drainage volume within 24 h postoperatively was 217.5-/+167.8 ml (80-680 ml).

The establishment of ECC system through peripheral vessels, certain learning curve of perfusion technique and close communication between the surgical team are the key points of ECC for totally robotically assisted cardiac surgery, and VAVD and continuous blood gas monitoring are essential during ECC.