Totally Endoscopic Robotic Atrial Septal Defect Repair

Atrial Septal Defect Anatomy

Anatomy of an atrial septal defect.

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.

Totally Endoscopic Atrial Septal Defect Robotic Ports.

Totally Endoscopic Atrial Septal Defect Robotic Ports.

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-b

Totally Endoscopic Atrial Septal Defect Robotic Ports.ased 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 (breastplate 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

 

amplatzer-asd-closure-device

AMPLATZER® Septal Occluder

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 (breastplate 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.

Below is a video of Dr. Guy performing an endoscopic robotic atrial septal defect repair:

T. Sloane Guy, Robotic Heart Surgeon

T. Sloane Guy, MD

Dr. Guy earned his MD and completed surgery residency and cardiothoracic surgery fellowship at the University of Pennsylvania. He has extensive training and experience in robotic cardiac surgery. He is a former Lieutenant Colonel in U.S. Army who served 3 tours as a combat surgeon in Iraq and Afghanistan. He is Professor of Surgery and Director of Robotic & Minimally Invasive Cardiac Surgery at Sidney Kimmel Medical College at Thomas Jefferson University Hospital in Philadelphia.

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Summary of Dr. Guy’s Background

EDUCATION
Wake Forest University, BS, 1989
Wharton School of Business, MBA, 1992
University of Pennsylvania School of Medicine, MD, 1994

TRAINING
University of Pennsylvania Surgery Residency, 2002
University of Pennsylvania Cardiothoracic Fellowship, 2004

ACADEMIC APPOINTMENTS
Uniformed Services University of the Health Sciences, 1995 - 2010
UC San Francisco, 2006-2010
Temple University School of Medicine, 2011-2015
Weill Cornell Medicine, 2015-2019
Thomas Jefferson University, Sidney Kimmel Medical College, 2019-present

BOARD CERTIFICATIONS
American Board of Surgery
American Board of Thoracic Surgery

ORGANIZATIONS
American Association for Thoracic Surgery
Society of Thoracic Surgeons
Heart Valve Society
Fellow, American College of Surgeons
Fellow, American College of Cardiology
International Society of Minimally Invasive Cardiothoracic Surgery
21st Century Cardiothoracic Surgery Society
New York Society of Thoracic Surgeons
T. Sloane Guy, MD

Have questions? Want to contact me directly?

Call 215-955-6996 or email me at sloane.guy@jefferson.edu

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