Da Vinci Robot-assisted Beating-Heart vs. Cardioplegic Arrest Atrial Septal Defect Repair: A Clinical Comparison of Feasibility and Outcomes
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Background Da Vinci robot-assisted cardiac surgery has emerged as an indispensable modality in minimally invasive cardiac surgery. This study aimed to compare the clinical outcomes of Da Vinci robot-assisted atrial septal defect (ASD) repair under beating-heart versus cardioplegic arrest conditions. Methods A retrospective cohort study was conducted on consecutive patients who underwent Da Vinci robot-assisted ASD repair at our institution from November 2014 to April 2024. Patients were stratified into two groups on the basis of the surgical approach: the cardioplegia arrest group ( n = 23) and the beating-heart group ( n = 75). General clinical data, perioperative parameters, postoperative recovery metrics, and early clinical outcomes were compared between the groups. Results A total of 114 patients underwent successful Da Vinci robot-assisted ASD repair, with no perioperative or 30-day mortality. Compared with the cardioplegic arrest group (n = 23), the beating-heart group (n = 75) presented a significantly shorter cardiopulmonary bypass (CPB) time (81.07 ± 20.95 min vs. 149.87 ± 50.50 min, P < 0.001), and eliminated aortic cross-clamping (0 ± 0 min vs. 71.43 ± 24.45 min, P < 0.001). The operative time was significantly shorter in the beating-heart group [200 (180–240) min vs. 260 (230–300) min, P < 0.001]. Postoperatively, the beating-heart group required less mechanical ventilation [11 (8–14) h vs. 15 (12–20) h, P = 0.001], had a lower 24-hour drainage volume [120 (70–200) mL vs. 230 (160–330) mL, P < 0.001], and had a shorter intensive care unit (ICU) stay [66 (42–80) h vs. 87 (63–94) h, P = 0.018]. Complication rates were comparable between the groups, with no residual shunts or severe arrhythmias. Conclusion Da Vinci robot-assisted beating-heart ASD repair is safe and feasible, avoids aortic cross-clamping-related risks, significantly reduces the CPB time, and offers postoperative recovery advantages.
