Endoscopic ventricular septal defect repair: experience at a single center

Objective: To report experience with cardiopulmonary bypass (CPB) management in totally endoscopic ventricular septal defect (VSD) repair at a single center. Methods: Retrospective review of 32 patients (Jan 2024–Aug 2025). Peripheral CPB via femoral artery and bicaval venous drainage using the Seldinger technique. Heparin 300 IU/kg to achieve ACT ≥ 480 s. The circuit included an oxygenator with integrated arterial filter; vacuum-assisted venous drainage (VAVD) ≤ 40 mmHg. Custodiol-HTK cardioplegia (~120 min protection). Moderate hypothermia (~32°C), controlled rewarming. CO₂ insufflation, standardized de-airing protocol. Results: Mean CPB and cross-clamp times were 161.3 ± 49.8 and 97.9 ± 39.8 minutes. Five patients (15.6%) required an additional femoral arterial cannula due to high line pressure. Ventilation averaged 6.4 hours; ICU stay 1 day; hospital stay 10.5 days. No in-hospital mortality. Conclusions: With standardized CPB checkpoints—appropriate cannulation, arterial line filtration, VAVD ≤ 40 mmHg, Custo cardioplegia, temperature and flow control, meticulous de-airing—totally endoscopic VSD repair can be performed safely with encouraging early outcomes.