Robotic-Assisted Patent Foramen Ovale Repair

A patent foramen ovale (PFO) is a small hole between the 2 upper chambers of the heart, the right and the left atrium. A robotic-assisted patent foramen repair is a type of surgery to fix this hole in the heart.

Normally, a wall separates the right and left atria. No blood can flow between them. If a PFO exists, a little blood can flow between the atria. This hole is normal in the heart before birth, as part of the fetal circulation. But in most people, it closes soon after birth. If it doesn’t close, you have a PFO.

A robotic-assisted patent foramen repair is a type of minimally invasive surgery. Minimally invasive means that the surgery uses smaller incisions than a traditional open heart surgery. You may have an easier and faster recovery.

Along with smaller cuts, your surgeon uses a robotic instrument to help fix your PFO. The robot has special tools attached to it. Your surgeon puts these tools and a camera through the small cuts. During the surgery, your surgeon sits at a nearby computer and controls the robot’s movements. Your surgeon is able to see the surgery with a highly magnified image.

The robotic tools may help surgeons do the surgery more exactly than they could with standard tools. Surgeons do this surgery while you are asleep under general anesthesia.

Most PFOs do not cause any symptoms. These do not need any treatment. But sometimes PFOs can lead to complications. The most significant of these is stroke. This happens when a traveling blood clot blocks a blood vessel in the brain. Though PFOs do not cause most strokes, having a PFO may slightly raise the risk for stroke in some people.

If you have no risk factors for stroke or any history of traveling blood clots, you usually will not get treatment. But if you have had such problems, your healthcare provider may want to treat your PFO.

Treatment for PFOs varies. In some cases, your healthcare provider may still choose not to treat the PFO. Another choice is medicine that helps prevent blood clots, such as aspirin or warfarin. Sometimes your healthcare provider will suggest closing the PFO by using a catheter. Closing the PFO during traditional heart surgery is another possible route.

Compared with a traditional surgical repair, a robotic-assisted minimally invasive repair may ease your pain after surgery. It may also allow you to recover more quickly. Plus it may give your surgeon more exact control compared with other types of minimally invasive PFO repair. It may decrease your risk for complications. Ask your healthcare provider what treatment makes sense for you.

Complications are rare with robotic-assisted PFO repair. But they do sometimes happen. Specific risks may vary based on your age, the size of your defect, and other health problems. Possible risks include:

• Abnormal heart rhythms. These can rarely cause sudden death.
• Surgical patch becomes unattached
• Tear in the blood vessels around the heart
• Infection
• Excess bleeding
• Puncturing the heart (rare)

There is also a risk that the procedure will not successfully fix the PFO. Ask your healthcare provider about your specific risks.

Talk with your healthcare provider about how to get ready for your surgery. If you smoke, try to stop smoking beforehand. It may lower your risk for complications. Tell your healthcare provider about all medicines you take, including over-the-counter medicines. Ask whether you need to stop taking any medicine beforehand. Do not eat or drink anything after midnight before your surgery.

You may need some routine tests before the procedure. These may include:

• Chest X-ray, to check your lungs
• Electrocardiogram (ECG), to check your heart rhythm
• Basic blood tests, to check your general health
• Cardiac catheterization, to look for blockages in the coronary arteries
• Echocardiogram, to evaluate your PFO

Check with your healthcare provider about the details of your surgery. In general, you can expect the following:

• Before the surgery starts, you’ll get general anesthesia. It will help you sleep deeply and painlessly through the operation.
• During the operation, staff will closely watch your vital signs. That includes your heart rate, blood pressure, breathing, and oxygen levels.
• Before and after the surgery, you may get antibiotics to help prevent infection.
• You will be attached to a heart-lung machine. This machine acts as your heart and lungs during the surgery.
• Your surgeon will make some small incisions in the spaces between your ribs.
• Your surgeon will put the robotic tools and a camera through these small incisions.
• While sitting at a nearby computer, your surgeon will do the operation using the robotic tools. The surgeon is always in control of these instruments.
• Your surgeon will look at continuous images from the robotic camera during this surgery.
• Your surgeon will fix the small hole between the upper heart chambers. A small surgical patch might be used to do so.
• Once the repair is done, the robotic tools, camera, and heart-lung machine will be removed.
• The small incisions on your chest will be closed. A bandage will then be applied.

After your robotic-assisted PFO repair, you will begin your recovery in the intensive care unit or a recovery room. When you first wake up, you might feel confused. You will be hooked up to several machines to monitor your vital signs more easily. You might also have a tube down your throat to help you breathe.

You should expect a little pain after your surgery. But it shouldn’t be severe. You can have pain medicine if you need it. You can have normal foods as soon as you can tolerate them. You will likely need to stay in the hospital for about 3 days.

Make sure someone drives you home from the hospital. You may also need some extra help at home for a little while.

A little draining of fluid from your incisions is normal. Tell your healthcare provider if you have severe draining, redness, or a fever. Also let your healthcare provider know right away if you have severe symptoms like sudden shortness of breath. You may have your stitches removed at a later appointment. Your healthcare provider will carefully watch you to make sure your surgery was successful.

You should need less recovery time than you would have from a standard PFO repair. But you still may tire easily for a while after your surgery. Get more active as soon as your healthcare provider says it is OK. Avoid lifting anything heavy for several weeks. Also follow all your healthcare provider’s instructions about medicine, exercise, diet, and wound care. It will help your recovery.

Sometime after your surgery, your healthcare provider may want to follow up with an echocardiogram with bubble study. This test can help make sure that you no longer have a hole in your heart.

Make sure all your healthcare providers and dentists know about your health history. You may also need antibiotics before some medical and dental procedures. It helps prevent an infection of the heart. Ask your healthcare provider whether this applies to you.

Before you agree to the test or the procedure make sure you know:

• The name of the test or procedure
• The reason you are having the test or procedure
• What results to expect and what they mean
• The risks and benefits of the test or procedure
• What the possible side effects or complications are
• When and where you are to have the test or procedure
• Who will do the test or procedure and what that person’s qualifications are
• What would happen if you did not have the test or procedure
• Any alternative tests or procedures to think about
• When and how will you get the results
• Who to call after the test or procedure if you have questions or problems
• How much will you have to pay for the test or procedure