Totally Endoscopic Atrial Septal Defect Repair on Beating Heart: Clinical Outcome and Single-Surgeon Learning Curve...

Area of Science:

• Cardiovascular Surgery
• Minimally Invasive Procedures
• Medical Technology

Background:

• Atrial septal defect (ASD) repair traditionally involves open-heart surgery.
• Minimally invasive techniques are increasingly explored to reduce patient recovery time and complications.
• Endoscopic approaches offer potential advantages in reducing surgical trauma.

Purpose of the Study:

• To evaluate the safety and efficacy of the Hanoi ASD procedure, a totally endoscopic surgery for ASD repair on a beating heart.
• To analyze the learning curve associated with the Hanoi ASD procedure.

Main Methods:

• A retrospective study of 198 consecutive ASD patients (weight ≥20 kg) from May 2016 to February 2023.
• The Hanoi ASD procedure involved femoral arterial cannulation, 5 mm trocars, a 15 mm port, and ASD repair on a beating heart with CO2 insufflation.
• Cumulative sum (CUSUM) analysis was employed to assess the learning curves for cardiopulmonary bypass (CPB) and operation times.

Main Results:

• Cardiopulmonary bypass (CPB) and operation times were 90 minutes and 180 minutes, respectively.
• No endoscopic failure or major complications were reported.
• CUSUM analysis identified three phases in the learning curve for CPB time, with 34 cases needed for technical efficiency and 54 for challenging cases.

Conclusions:

• The Hanoi ASD procedure is a safe and feasible option for endoscopic ASD repair in patients weighing ≥20 kg.
• The learning curve analysis suggests a significant number of cases are required to achieve proficiency.
• This endoscopic technique demonstrates promise for improved patient outcomes in ASD management.