Atrial septal defects (ASD’s) are an abnormal connection (or “hole”) between the left and right atria (chambers) of the heart. Over time, these defect, if large enough, can cause heart failure, lung problems, and stroke. Eventually, the extra blood flow that is abnormally diverted to the lungs causes irreversible injury to both the heart and the lungs. All of this is completely avoidable if the defect is closed prior to developing these complications.
Many of these can be closed with catheter-based techniques but some cannot. These types include large secundum type ASD’s, septum primum ASD’s, coronary sinus ASD’s, and sinus venosus ASD’s. We can also repair a similar condition called “partial anomalous pulmonary venous return”. Some patients prefer a surgical approach due to the small but known long-term device-related complications associated with placing a device in the heart. That being said, the current recommendation is to close these with catheter-based procedures such as the AMPLATZER® device due to data showing that the complication rate is lower with these procedures versus surgery. However, these data were comparing traditional open surgery performed through a sternotomy (breast plate sawed open) versus the catheter approach rather than an endoscopic robotic approach. I always discuss this with patients so that they can make informed choices themselves.
Animation of Robotic Atrial Septal Defect Repair
To perform the operation with a totally endoscopic robotic technique, the patient is placed on heart-lung bypass using a peripheral catheter (cannulation) system as for other intracardiac procedures. We usually use a patch to close the defect much like you would close a hole in your clothes! This patch can be from a variety of materials although we most often use the patient’s own tissue (pericardium which is the leathery sac the heart sits it).
Most centers repair these defects using either a sternotomy (breast plate divided) or a right thoracotomy (an incision under the right breast usually with rib spreading. Our approach is to repair these with totally endoscopic ports only as for other intra-cardiac procedures. We will usually patch the hole with the patient’s own tissues (pericardium). If the mitral valve is involved such as in ostium primum ASD, the mitral valve can be repaired at the same time.