Experiences in Surgical Closure of Atrial Septal Defect with Anterior Mini-Thoracotomy Approach

Abstract

Introduction: Anterior mini-thoracotomy approach is a good alternative to median sternotomy in Atrial Septal Defect (ASD) repair. Our purpose is to explain the details of our technique and peresent the results. Methods: Seventy five patients with ASD (52 female and 23 male) were operated with anterior mini-thoracotomy approach in our tertiary center between March 2012 and March 2014. The mean age was 14±10 ranged from 2 to 42 years. Outcomes were defined according to cardiopulmonary and aortic cross-clump time, intensive care unit stay time, morbidity, mortality, the size of incision, the amount of post-operative bleeding, need for blood transfusion and reoperation. Results: Mean Cardiopulmonary bypass time was 49.62 minutes (26 to 105 minutes) and mean aortic cross clamp time was 22.29±6.77 minutes (11 to 47 minutes). The mean amount of blood transfusion was 47.49± 62.22 mm (0 to 200 cc) and the mean chest tube drainage after surgery was 80.17 ±121.06 mm (0 to 600 cc). One patient re-operated for dehiscence of ASD surgical sutures and there was no reoperation for surgical bleeding or tamponade drainage in these patients. In 74 cases the defect was secundum type, in 2 patients it was sinus venosus type and in one with associated partial Anomalous repair. Conclusion: Anterior thoracotomy approach is safe and may be the surgical technique of choice for secundum ASD repair in all age groups and we can utilize this technique also for more complicated kinds of surgery for instance, sinus venosus type ASD with or without Partial Anomalous Defect.

Mini-thoracotomy versus median sternotomy for atrial septal defect closure: Should mini-thoracotomy be applied as a standard technique?

“…[9] The benefit of recovery and rehabilitation in the postoperative period is reflected in the duration of intensive care and hospital stay. [10] In our study, the duration of mechanical ventilation, amount of drainage, and length of intensive care unit and hospital stay were found to be statistically significantly shorter in the MICS-RAT group than in the MS group. However, there were no significant differences in bleeding revision, postoperative blood use, and pulmonary or renal dysfunction.…”

Surgical Closure of Atrial Septal Defects in Young Children—A Review of Anesthesia Care in Sternotomy and Thoracotomy Approaches

“…Times reported were comparable to those for ASD closure via anterior mini thoracotomy reported by Baharestani et al (mean CPB time 49.62 min [26-105 min] and mean aortic cross-clamp time was 22.29 § 6.77 min [11-47 min]). 18 Chang et al reported the duration of cardiopulmonary bypass as 27-to-126 minutes (42 § 12) in the minimally invasive (MICS) group and 14-to-158 (27 § 11) minutes in the sternotomy (MS) group. The duration of surgery was 1.8-to-4.7 (2.8 § 0.8) hours in the MICS group and 1.6-to-4.6 (2.9 § 0.8) hours in the MS group.…”

Atrial septal defect closure via right mini-thoracotomy: Our single center experience

“…This approach provides excellent exposure and cosmetic outcomes for female patients. Baharestani et al [9] reported 75 patients undergoing successful mini-thoracotomy with central cannulation technique. The cosmetic results of these alternative approaches were found to be satisfactory.…”

“…[9] In the present study, we report our earlymidterm results of the largest patient population in the literature for the atrial septal defect (ASD) closure with the only central cannulation technique through the right mini-thoracotomy incision.…”