Intermediate-Term Outcomes of Totally Endoscopic Atrial Septal Defect Repair on Beating Heart in Small Children

Area of Science:

• Pediatric Cardiac Surgery
• Minimally Invasive Techniques
• Congenital Heart Disease

Background:

• Totally endoscopic surgery (TES) for congenital heart disease presents challenges in narrow surgical fields and risks of femoral arterial (FA) complications in small children.
• Existing techniques often face limitations in pediatric patients due to anatomical constraints and potential vascular issues.

Purpose of the Study:

• To evaluate the feasibility and safety of TES for atrial septal defect (ASD) repair in pediatric patients weighing between 13 and 20 kg.
• To assess the efficacy of optimized surgical field management and FA cannulation techniques in this specific patient cohort.

Main Methods:

• A prospective study involving 14 pediatric patients (mean age 5.4 years, weight 13-20 kg) undergoing TES for ASD repair on a beating heart.
• Utilized Dacron graft for FA cannulation with a smaller-sized backup cannula, CO2 insufflation, and avoided aortic clamping and inferior vena cava snaring.
• Employed three 5-5.5 mm trocars and one 12 mm port for instrument access.

Main Results:

• Successful cardiopulmonary bypass (CPB) installation and maintenance with mean CPB time of 113.1 minutes and operation time of 209.6 minutes.
• No severe complications, including arterial complications, were observed during a mean follow-up of 37.9 months.
• Patients experienced reduced postoperative pain, with no need for analgesics by postoperative days 4-5.

Conclusions:

• Optimized surgical field management and precise FA cannula placement enable the safe and feasible application of TES for ASD closure in small children (13-20 kg).
• This minimally invasive technique offers a viable and safe alternative to conventional surgery for selected pediatric ASD cases.