Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Sternotomy”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,027 records · Page 57Linked to original sources
PubMed1992

[Hepatic elimination of thiopental in heart surgery patients].

Thiopental is a hypnotic drug that is widely used for the induction of anaesthesia. The mechanism of the short-term action is based on the rapid distribution of the drug, and in contrast to methohexital, the metabolism of thiopental is not relevant in use in conditions of operative anaesthesia. However, in neurotraumatology thiopental is frequently used as continuous infusion for several days to reduce cerebral metabolism. Under these circumstances, the elimination of thiopental becomes the most important factor for the duration of action. In order to clarify the relative contribution of the liver to the disposition of thiopental, hepatic blood flow was measured during the induction of anaesthesia and at sternotomy combined with the determination of plasma concentrations of the drug in arterial and hepatic venous blood, making it possible to calculate the hepatic and total plasma clearance of thiopental. METHOD. The study was thoroughly discussed and approved by the local ethics committee, and all patients gave informed written consent. The investigation was performed in 10 male patients (as detailed in Table 1), who had been referred for elective coronary artery bypass surgery. The determination of hepatic plasma flow was performed by the indocyanine green (ICG) infusion extraction technique using liver vein catheterization. Before induction of anaesthesia (MP1), after induction (MP2) and at sternotomy (MP3), hemodynamic data (heart rate, arterial pressure, cardiac output) were recorded and blood samples for the determination of hepatic plasma flow by the concentration of ICG were collected. Additionally, arterial and hepatic venous plasma concentrations of thiopental were determined by gas chromatography after induction until the extracorporeal circulation was started. Anaesthesia was induced with a bolus dose of thiopental 4 mg/kg body wt, fentanyl 7 micrograms/kg and pancuronium 0.1 mg/kg and maintained with a continuous infusion of fentanyl 20 micrograms/min and mechanical ventilation with O2/N2O at an FiO2 of 0.5. RESULTS. Median arterial pressure (MAP) decreased from 89 mmHg to 74 mmHg after induction and rose again to reach 104 mmHg at sternotomy. Cardiac output (HZV) also decreased from 6.17 l/min to 4.76 l/min after induction, but remained unchanged at sternotomy (Table 2). Hepatic plasma and blood flow showed no significant changes but tended to decrease after the induction of anaesthesia. Hepatic blood flow was constantly 26-28% of cardiac output. In the same way, intestinal oxygen consumption (VO2) did not change significantly, but the tendency was identical to that with hepatic perfusion. Hepatic clearance of thiopental as the product of hepatic extraction of thiopental (with a median value of 0.29) and hepatic plasma flow was 0.21 l/min. CONCLUSIONS. Thiopental is subject to a relatively low hepatic extraction of 0.29. Thus, changes in hepatic perfusion do not influence the elimination of thiopental. The actions of thiopental on global hemodynamics are comparable with the results found in the literature, characterized by a significant reduction in MAP and cardiac output after induction. The hepatic clearance of thiopental found in this study, with an absolute value of 0.21 l/min, is absolutely comparable with the data for total-body clearance reported in the literature. It is concluded that the liver is the only organ responsible for the elimination of thiopental in humans.

Adult↗
PubMedDate not supplied

Atherosclerotic disease of the innominate artery: current management and results.

Arterial repair through a sternotomy has long been considered the procedure of choice for innominate artery atherosclerotic disease. Of 22 patients presenting with 21 occlusive lesions and one aneurysm, 17 patients underwent a bypass procedure, and two, an endarterectomy through a sternotomy, whereas three patients underwent cervical procedures. Their postoperative course was uneventful. Early and late results were satisfactory. We conclude that in patients with innominate artery atherosclerotic disease, the procedure employed depends on both the type of lesion and the clinical status of the patient. In most cases, a bypass graft via a sternotomy is the best option, since endarterectomy is not always possible and risks an aortic tear or dissection. In selected cases, balloon angioplasty performed either percutaneously, combined with cerebral protection by an occlusive balloon in the carotid artery or through a carotid arteriotomy in order to flush out embolic material may be sufficient. A by-pass graft from the right to the left common carotid artery is the best procedure in patients with neurological symptoms when angioplasty seems inappropriate, and when sternotomy is contraindicated for either reasons of poor health or a prior mediastinal operation.

Adult↗
PubMed2006

[Injury to major blood vessels in anterior thoracic and lumbar spinal surgery].

PURPOSE OF THE STUDY: The anterior approach to the thoracic and lumbar spine is used with increasing frequency for various indications. With the advent of prosthetic intervertebral disc replacement, its use has become even more frequent and has often been associated with serious complications. The aim of this study was to evaluate vascular complications in patients who underwent anterior spinal surgery of the thoracic and lumbar spine. MATERIAL: We performed a total of 531 operations of the thoracolumbar spine from the anterior approach. In 12 cases, after exposure of the body of the first or second thoracic vertebrae, we employed the Smith-Robinson technique to expose the cervical spine. We used sternotomy in six, posterolateral thoracotomy in 209, the pararectal retroperitoneal approach in 239, anterolateral lumbotomy in 58 and the transperitoneal approach in seven patients. The aim of surgery was somatectomy in 190 patients and discectomy in 341 patients. Sternotomy and transperitoneal approaches were carried out by a thoracic or vascular surgeon and all the other procedures were done by the first author. The indications for spinal surgery included an accident in 171, tumor in 56, spondylodiscitis in 43 and a degenerative disease in 261 patients. METHODS: All patients indicated for anterior spinal surgery were examined by conventional radiography in two projections, and this was completed by CT sagittal and frontal reconstructions of the affected region. Most patients also underwent MR imaging. The Smith-Robinson approach was used for exposure of T1 or T2. Sternotomy was indicated for treatment of T2-T4 and also T1 in the patients with a short, thick neck. Access to T3-L1 was gained by posterolateral thoracotomy, in most cases performed as a minimally invasive transpleural procedure. For access to the lumbar spine we usually used the retropleural approach from a pararectal incision or lumbotomy. We preferred the pararectal retroperitoneal approach in L2-S1 degenerative disease, L5 fractures, and L5-S1 spondylodiscitis. We carried out lumbotomy in patients with trauma, tumors and L1-L4 spondylodiscitis. The transperitoneal approach from lower middle laparotomy was used only in tumors at L5 or L4. For treatment of trauma and degenerative disease of the lumbar spine we preferred less invasive procedures, and for tumors and spondylodiscitis we used more extensive exposure because of the difficult terrain. The patients were followed up for 2 to 96 months (average, 31.4 months) after anterior spinal surgery. RESULTS: In 12 patients treated by the Smith-Robinson procedure and in six patients undergoing sternotomy, neither early nor late signs of any injury to major blood vessels or internal organs were recorded. The 209 patients with posterolateral thoracotomy were also free from any signs of vascular injury, but trauma to the thoracic duct was recorded in one case. We found injury to major blood vessels in three patients in the group treated by the pararectal retroperitoneal procedure. In the total of 531 anterior spinal surgery procedures this accounts for 0.56 %; of the 304 lumbar operations and 239 pararectal retroperitoneal operations it is 0.99 % and 1.26 %, respectively. In one patient the vascular injury was associated with trauma to the ureter. DISCUSSION: In our group of 531 patients we found a higher risk of vascular injury when the L4-L5 segment was treated, when less invasive surgery was used or when spinal anatomy was altered due to tumor or spondylodiscitis. All the complications were recorded in the first 250 patients. It should be emphasized that, because in five patients, the planned anterior spondylodesis would have been associated with high risk due to altered anatomy of the bifurcation of the aorta, these patients were treated by dorsal instrumented spondylodesis. We also avoided the anterior approach for revision spinal surgery and used the posterior approach instead. Vascular complications were treated in cooperation with a vascular or cardiac surgeon. In the most serious case, if a sophisticated cardiosurgical technique had not been immediately available, the patient would probably have died. CONCLUSIONS: The technique of anterior approach is safe only in the hands of experienced spinal surgeons with long experience. In institutions where anterior spinal surgery is not a routine method it is advisable to involve a vascular or cardiac surgeon. However, the most important point is to know when not to operate.

Adolescent↗
PubMedDate not supplied

Acute sternal opening after cardiac surgery in children: effect on plasma atrial natriuretic peptide.

Plasma atrial natriuretic peptide (ANP) was measured immediately before and 15 minutes after re-opening of the sternotomy and delayed sternal closure were performed to alleviate possible myocardial compression in 3 children. As acute re-opening of the sternotomy is a rare occurrence our sample size was necessarily small. ANP increased following the procedure in all 3 patients, and this was significant (p less than 0.02) when compared to plasma levels obtained from 9 children who underwent sternotomy prior to elective cardiac surgery. Following acute re-opening of the sternotomy there was an increase in median urine output and a decrease in median central venous pressure. Our results illustrate that it is atrial wall stress rather than intra-atrial pressure that determines release of ANP, and in addition suggest ANP may be a factor in the rapid clinical improvement following delayed sternal closure for atypical tamponade in children.

Atrial Natriuretic Factor↗
PubMedDate not supplied

[Endothoracic goiter operated on by cervicosternotomy. Apropos of 18 cases].

From 1968 to 1992, 18 sternotomies were performed on a total amount of 225 operated substernal goiters (8% of cases). These operations concerned 14 females and 4 males aged of about 67.8 years. 7 patients had already been operated of a goiter within 1 to 50 years. The substernal goiter was discovered on a systematic x ray chest 5 times, and a x-ray scanner once, also clinical symptoms were still present with compressive troubles in 16 times (particularly acute dyspnea 3 times). The sternotomy was always total. It was only required if the operative problems were important at the time of the cervicotomy. Indications for sternotomy were:--impossibility to extraction due to the volume of the goiter 10 times, (including 5 recurrent goiters), independent retrosternal goiter without cervical connexion, 2 times (including 2 recurrent goiters), hemorrhagic linkage, 3 times, invasive cancer, 3 times. Excluding the 3 invasive cancers, the mortality was inexistant and the morbidity very low, especially without respiratory problems. Post operative complications were 2 definitive hypoparathyroidism and 1 regressive recurrential palsy (plus 2 recurrential palsy still present before the operation). The authors pointed out the good tolerance of the sternotomy which, in special case, should be absolutely preferable the cervicotomy alone, in order to reduce the operative risks, especially hemorrhagic and nervous.

Aged↗
PubMed1994

[Value of pedicled myoplasty in the treatment of severe mediastinitis. A case report].

Sternotomy is the approach of choice for cardiac surgery. Mediastinitis is a rare complication of median sternotomy with high morbidity and mortality. We describe a case of severe mediastinitis occurring after median sternotomy performed in a patient presenting diving goiter. Two-stage irrigation/drainage was unsuccessful. This failure led to opening of the chest and coverage with a pediculated flap using the grand pectoralis muscle. This stratagem allowed complete healing. This case provides an opportunity to discuss the different surgical techniques used to treat severe mediastinitis and to emphasize the value of muscle flaps in the management of recalcitrant median sternotomy wounds.

Drainage↗
PubMed1993

[Surgical results in atherosclerotic distal aortic arch aneurysm].

Results of surgical treatment of atherosclerotic aneurysm of the distal aortic arch, reported to date, are not satisfactory. We recently analyzed the surgical results in 119 patients with this condition who were treated at our department. There were 104 males and 15 females, ranging in age from 38 to 81 years (mean: 66 years). The arch was reconstructed by total replacement in 29 cases, partial replacement in 49 cases, patch reconstruction in 34 cases and extra-anatomic bypass in 7 cases. The lesion was approached by median sternotomy in 75 cases, median sternotomy+left thoracotomy in 9 cases and left thoracotomy in 35 cases. In cases where median sternotomy was used, selective cerebral perfusion was generally employed as an auxiliary procedure. After surgery, cerebral complications were observed in 19 cases (16.0%). In 15 of these 19 cases, postoperative cerebral damage was attributed to atheromatous emboli. Twenty-six patients (21.8%) died in the hospital. Major causes of death included respiratory insufficiency, multiple organ failure and low cardiac output syndrome. To improve surgical results for this type of aneurysm, the operative procedure needs to be modified so that these postoperative complications are prevented. Especially it is essential to prevent intraoperative embolisms of brain and coronary arteries, and a reconstruction by total arch replacement with median sternotomy has improved recent surgical results.

Adult↗
PubMed1998

Limited access atrial septal defect closure and the evolution of minimally invasive surgery.

While minimizing the "invasiveness" in general surgery has been equated with minimizing "access", what constitutes minimally invasive intra-cardiac surgery remains controversial. Many surgeons doubt the benefits of minimizing access when the need for cardiopulmonary bypass cannot be waived. Recognizing that median sternotomy itself does entail significant morbidity, we investigated the value of alternative approaches to median sternotomy using atrial septal defect closure as our investigative model. We believe that some, but not all minimal access approaches are associated with reduced postoperative morbidity and enhanced recovery. Our current strategy is to use a mini-sternotomy approach in adult patients, whereas conventional median sternotomy remains our standard approach in the pediatric population. Considerable clinical experiences coupled with documented clinical benefits are fundamental before a certain approach is adopted in routine practice.

Adult↗
PubMed1994

Rigid internal fixation of the sternum in postoperative mediastinitis.

OBJECTIVE: The current standard treatment of mediastinitis following median sternotomy is radical sternal débridement and obliteration of anterior mediastinal dead space with muscle or omental flaps. This report describes and reviews our experiences with a new technique of sternal salvage based on osseous quantitative bacteriologic assessment and rigid fixation in patients with postoperative mediastinitis. DESIGN: A retrospective review of 29 patients treated with sternal rigid internal fixation. SETTING: Two tertiary care academic medical centers in Chicago, Ill, and Ann Arbor, Mich. PATIENTS: Patients with postoperative mediastinitis following median sternotomy who underwent rigid internal fixation of retained sternum. INTERVENTION: Following débridement, quantitative bacteriologic assessment and sternal vascularity were assessed. Sternal segments with good vascularity and in bacteriologic balance were anatomically reduced and rigidly fixed to each other with titanium miniplates in 24 patients with postoperative mediastinitis. Five of the 29 patients, at high risk for mediastinitis, underwent rigid internal fixation immediately after their cardiac procedure. MAIN OUTCOME MEASURES: Resolution of infection, wounds remaining closed, and stable sternums. RESULTS: Bony union was obtained in 27 (93%) of 29 patients. The postoperative hospital stay ranged from 5 to 84 days, with a mean stay of 17 days and a median stay of 7 days. Length of stay was directly related to pulmonary function, which correlated with preoperative intubation status. CONCLUSIONS: Radical sternal débridement may not be necessary in all patients with postoperative mediastinitis following median sternotomy. Sternal salvage can safely and reliably be performed with a combination of clinical assessment of vascularity and osseous quantitative bacteriologic assessment. Anatomic reduction of the viable sternal segments is possible even in severely osteoporotic bone.

Adolescent↗
PubMed1994

Breast size as a risk factor for sternal wound complications following cardiac surgery.

OBJECTIVE: To determine if macromastia is associated with risk for deep sternal wound infection following cardiac surgery via median sternotomy incision. DESIGN: Case-control study. SETTING: Private urban teaching hospital. PARTICIPANTS: Women who developed deep sternal wound infection after undergoing cardiac surgery via median sternotomy incision and a random sample of women who did not develop infection following the same surgery. OUTCOME MEASURES: Odds ratios (ORs) were used to compare the development of deep sternal wound infection in women who wore large bra cups (size D or DD) with women who wore small bra cups (size A or B) and to compare women who wore medium bra cups (size C) with those who wore small bra cups. RESULTS: For women who wore large bra cups, the OR for deep sternal wound infection was 38.5 (95% confidence interval [CI], 5.6 to 265.8) compared with women who wore small bra cups. For women who wore medium bra cups, the OR for deep sternal wound infection was 12.3 (95% CI, 2.2 to 68.7). The multivariate adjusted ORs, controlling for body mass index, internal mammary artery grafting, diabetes, and age, were 42.1 (95% CI, 3.7 to 477.3) for women who wore large bra cups compared with women who wore small bra cups and 14.9 (95% CI, 1.7 to 129.7) for women who wore medium bra cups compared with women who wore small bra cups. CONCLUSIONS: Large and medium bra cups sizes are associated with an increased risk for deep sternal wound infection after undergoing cardiac surgery via median sternotomy incision.

Aged↗
PubMed2001

Mitral valve replacement through right thoracotomy after coronary arterial bypass grafting with functioning conduits.

A 67-year-old man who had undergone coronary artery bypass grafting 3 years previously suffered from severe mitral regurgitation associated with Streptococcal infective endocarditis. He was placed in New York Heart Association functional class III. Preoperative angiography demonstrated good opacification of all 3 conduits implanted in the previous operation. We replaced the mitral valve through an anterolateral right thoracotomy, approaching the mitral valve as an alternative to redoing sternotomy to minimize potential injury to patent grafts. His postoperative course was uneventful. After a 1-month course of antibiotics, the patient was discharged as New York Heart Association class II and at present, 3 months after discharge, is doing well. This approach is an effective alternative to redoing sternotomy for mitral valve operation, especially in patients undergoing a previous coronary arterial bypass grafting via median sternotomy.

Aged↗
PubMed1982

Haemodynamic and plasma vasopressin responses with high-dose fentanyl anaesthesia during aorto-coronary bypass operations.

Twelve male patients were given high dose fentanyl (75-100 microgram.kg-1) anaesthesia with oxygen during elective aorto-coronary bypass operations, and their haemodynamic and vasopressin responses were determined during induction, sternotomy, cardiopulmonary bypass, post-bypass and recovery periods. For comparison, a group of 12 male patients were anaesthetized with morphine, halothane 0.5 per cent, nitrous oxide and oxygen, and were similarly studied. Significant alterations in haemodynamics included increased mean arterial pressure after sternotomy in the fentanyl group, increased heart rate in both groups, increased systemic vascular resistance after sternotomy only in the halothane group, and decreased left ventricular stroke work index in both groups following induction, bypass, and during the recovery periods. Plasma vasopressin levels increased significantly in both groups during the bypass period, but returned to baseline levels following bypass. Serum sodium and osmolality did not change significantly, and urinary sodium and potassium excretion rose with the progress of the operation in both groups. A positive correlation was found between mean arterial pressure and vasopressin only in the halothane group. Systemic vascular resistance was correlated to vasopressin levels in both groups. Vasopressin response in both groups was similar, with significant but relatively low increases in levels during cardiopulmonary bypass. Fentanyl-oxygen anaesthesia did not provide haemodynamic stability in eight of 12 patients.

Adult↗
PubMed1999

Aortic valve replacement after retrosternal gastric tube reconstruction for esophageal cancer.

A 59-year-old man with a history of the thoraco-abdominal esophagus resection with retrosternal gastric tube reconstruction for esophageal cancer complicated by anastomosis leakage and purulent pericarditis was admitted for aortic regurgitation due to infective endocarditis. Floppy vegetation and worsening cardiac failure indicated aortic valve replacement. In a median sternotomy approach, the thickest adhesion between the cervical esophagus and posterior surface of the manubrium sternae was freed using an ultrasonic osteotome. Severe adhesions in the pericardium due to purulent pericarditis were found. Median sternotomy enabled minimal exposure of the aortic root, upper right atrium, and right superior pulmonary vein for instituting extracorporeal circulation and replacing the aortic valve. The patient's postoperative course was uneventful. For cardiac surgery in patients with a retrosternal gastric tube, left anterior or right thoracotomy may be considered to avoid gastric tube injury. Median sternotomy, however, is an alternative enabling safe heart exposure, and the ultrasonic osteotome was very useful in incising the sternum without injuring the cervical esophagus, which had no serosa.

Aortic Valve↗
PubMed1999

Lung volume reduction surgery results in pulmonary emphysema. Changes in pulmonary function.

From December 1993 to August 1998, we conducted 57 lung volume reduction surgeries on patients with severe pulmonary emphysema but without giant bullae. Of these, 26 underwent unilateral lung volume reduction surgery and 31 bilateral surgery. We analyzed the results of thoracoscopic lung volume reduction surgery (unilateral: 25; bilateral: 16) and volume reduction surgery by median sternotomy (unilateral: 1; bilateral: 15). Bilateral surgery via thoracoscope and median sternotomy significantly improved symptoms and pulmonary functions; mean improvement in forced expiratory volume in 1 second was 42.4% for bilateral thoracoscopic volume reduction surgery and 60.0% for median sternotomy. Unilateral volume reduction surgery produced a mean improvement in forced expiratory volume in 1 second of 28.9%. No significant complications were seen with either procedure. Reevaluation at 1 and 2 years after lung volume reduction surgery showed improvement to be well maintained.

Aged↗
PubMed1991

The healing sternum: a comparison of osseous healing with wire versus rigid fixation.

Although median sternotomy is used for most cardiac procedures, postoperative dehiscence remains a serious and persistent problem. This investigation was designed to assess new bone formation and sternal healing across the linear osteotomy of the sternum and to determine if rigid fixation would enhance bony healing and thus decrease unfavorable sequelae. To test this hypothesis, 14 skeletally mature baboons (Papio anubis) underwent standard median sternotomy; seven sternotomies were closed with interrupted 24-gauge cerclage wires, and seven, with thin Vitallium compression miniplates and transverse lag screws. The sterna from each group were harvested en bloc at 4 and 8 weeks, radiographed, processed, and serially sectioned and stained for histomorphometry to assess the quantity of new bone across the linear osteotomy. Clinical stability was superior with the plated and lag screw group at 4 weeks; however, by 8 weeks, no clinical difference between treatments was apparent. Histomorphometric analysis indicated that the linear osteotomy gap treated with plates and screws was less than the gap associated with the wire group. Rigid fixation of the sternum resulted in earlier union with primary osseous healing, suggesting greater inherent stability. these factors may decrease adverse sequelae for this procedure.

Animals↗
PubMed1992

Julian's reintroduction of Milton's operation.

Four years after the first successful open heart operation in 1953, most cardiac surgeons were using bilateral anterior thoracotomy. This tedious, time-consuming, complication-prone, painful procedure was abandoned only after Julian and associates demonstrated the marked superiority of median sternotomy. Although median sternotomy was described by Milton in 1897, it was a seldom-used procedure at the time of Julian and associates' publication in 1957. The present-day routine use of median sternotomy for virtually all cardiac operations is a testimonial to the foresight and practicality of Julian's experience.

Cardiac Surgical Procedures↗
PubMed1992

Total intravenous anesthesia for infants and children undergoing correction of tetralogy of Fallot: sufentanil versus sufentanil-flunitrazepam technique.

The effects of two total intravenous anesthetic techniques were compared in 20 infants and children undergoing primary correction of tetralogy of Fallot (TOF). All patients (mean body weight, 11.4 +/- 4.2 kg; range, 6 to 20 kg; mean age, 32 +/- 21 months, range, 7 to 85 months) were premedicated with atropine, 0.02, mg/kg, morphine, 0.2, mg/kg, and flunitrazepam, 0.04 mg/kg, intramuscularly, 1 hour preoperatively. Anesthesia was induced with 1 microgram/kg of sufentanil (S) and pancuronium, 0.1 mg/kg, intravenously. Patients were ventilated with 100% oxygen. Hemodynamic parameters, heart rate (HR), systolic (SBP), diastolic (DBP) and mean arterial blood pressure (MAP), central venous pressure (CVP), and peripheral arterial blood oxygen saturation (SaO2) were recorded. Plasma concentrations of S, epinephrine (E), norepinephrine (NE), and blood gases were determined. To obtain a further depth of anesthesia, 10 patients (SM group) received 4 micrograms/kg of S and 10 patients (SF group) received 4 micrograms/kg of S in combination with flunitrazepam, 40 micrograms/kg, in a randomized manner. Measurements were made before and after induction of anesthesia, before and after anesthetic loading, 2 minutes after sternotomy, 15 minutes after initiation of extracorporeal circulation (ECC), and at sternal closure. Peak values for plasma S concentrations of 3.14 +/- 1.13 (SM group) and 3.45 +/- 97 ng/mL (SF group) were found before sternotomy. Following intubation HR, SBP, DBP, and MAP remained close to values measured before induction, but SaO2 increased significantly (P less than 0.01) in all patients. HR, SBP, and MAP decreased during anesthetic loading in both groups. Hemodynamics and plasma E and NE remained essentially unchanged after sternotomy in the SF group.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, Intravenous↗
PubMed2004

Robotic techniques improve quality of life in patients undergoing atrial septal defect repair.

BACKGROUND: Minimally invasive cardiac surgery has emerged as an alternative to conventional, open surgery. Although most studies of robotically assisted cardiac surgery have reported morbidity and mortality, few have addressed outcome measures, such as pain and quality of life, which was the aim of this study. METHODS: Eleven patients with atrial septal defects (ASD), and five patients with patent foramen ovale, underwent repair using the Da Vinci system (Intuitive Surgical, Mountain View, CA). The Medical Outcomes Study Short Form Survey (SF-36), along with two additional questions, were administered to these patients on postoperative day 30, along with a similar number of patients who underwent ASD repair by mini-thoracotomy or sternotomy. Quality of life endpoints included bodily pain, vitality, mental health, general health, physical function, and social function. RESULTS: Robotic patients demonstrated significantly higher scores in 6 of the eight variables (p < 0.05). There was no significant difference in intensive care unit or overall hospital stay among the groups (p = NS). Robotic patients returned to work after 40.2 +/- 30.2 days, mini-thoracotomy patients after 45.6 +/- 27.9 days, and sternotomy patients after 51.7 +/- 40.2 days (p = 0.767). There were no significant differences in SF-36 scores between patients who underwent mini-thoracotomy and sternotomy approaches. CONCLUSIONS: Closure of an ASD can be performed safely and effectively via an endoscopic approach. Robotic technology minimized the degree of invasiveness, hastened postoperative recovery, and improved quality of life, although length of hospital stay was unchanged.

Adult↗