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Robotic Approach For Surgical Correction Of Scimitar Syndrome
David Blitzer, Krushang Patel, Morgan Moroi, Michael LaLonde, Emile Bacha, Arnar Geirsson.
Columbia University, New York, NY, USA.
Objective(s): Scimitar syndrome (SS) is defined by complete or partial anomalous pulmonary venous return (PAPVR) of the right lung into the inferior vena cava (IVC). We describe complete robotic repair for a case of scimitar syndrome in a 32 year old female.
Methods: Port incisions were made in the right 2nd, 3rd, and 5th intercostal spaces. The patient was heparinized, and cardiopulmonary bypass instituted via the left femoral artery, and the right internal jugular and femoral veins. After docking the robot, the scimitar vein (SV) was identified, dissected free down to the IVC and divided with a vascular stapler. An IntraClude intra-aortic occlusion device (Edwards Lifesciences, Irvine, CA, USA) was inflated in the ascending aorta and cardioplegia administered. The SV was controlled distally with a vessel loop and the staple line removed. An end-to-side anastomosis between the SV and left atrium was performed using two CV5 GoreTex sutures (W.L. Gore & Associates, Newark, DE, USA). After ensuring a tension free anastomosis, the IntraClude was deflated and cardiopulmonary bypass weaned.
Results: The heart had good biventricular function on transesophageal echocardiography and the mean gradient at the level of the inferior pulmonary vein was 2 mm Hg. The patient was extubated in the operating room and arrived in the intensive care unit without inotropic or vasopressor requirement. She was transferred to the stepdown unit on post-operative day 1 and discharged home on post-operative day 4.
Conclusions: A robotic approach for the surgical repair of SS is safe and effective in select patients.
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