Lower Ministernotomy and Fast Tracking for Atrial Septal Defect

Abstract

We report our experience with a 3-5-cm lower ministernotomy incision for closure of atrial septal defect in 53 patients. Fibrillatory arrest was used in 19 patients, and crossclamping with cardioplegia in 33. One patient had to be converted from fibrillatory arrest to crossclamping with cardioplegic arrest. The mean bypass time was 39.6 +/- 13.1 min, arrest time was 9.9 +/- 4.5 min, and crossclamp time was 20.7 +/- 8.69 min. All patients recovered without adverse events. They were fast tracked to recovery and extubated after 63.4 +/- 9.2 min. The mean intensive care unit stay was 1.07 +/- 0.33 days, and hospital stay was 3.07 +/- 0.38 days. The ministernotomy approach was used successfully in 51 patients; in the other 2, it had to be converted to a full sternotomy because of technical difficulties. Our experience confirms that this technique offers satisfactory cosmetic results, stable sternal reconstruction, good surgical exposure, minimal interference with respiratory mechanics, and minimal pain, allowing extubation in the operating room and a speedy recovery.

Full sternotomy with limited skin incision for surgical treatment of atrial septal defect

“…In case there is a need to split the sternum more than usual, in rare cases, there may be an injury to one or more intercostal neurovascular bundles or instability in the anterior chest wall. [1,5,7] In our patients, we did not observe such complications.…”

“…Finally, it is less painful than a minithoracotomy. [4,5] Right minithoracotomies or inframammary incisions have been supported particularly in female patients where the inframammary fold helps to cover the incision. The cosmetic results of these alternative approaches have been reported to be satisfactory, but specific complications related to the incision have been seen.…”

Ministernotomy for correction of ventricular septal defect

“…Sebastian et al [ 9 ] found no differences in the number of blood transfusions but a prolonged cardiopulmonary bypass and cross-clamp times in the ministernotomy group. The issue of increased surgical time with minimally invasive surgery is encountered not only with ministernotomy, but also with other less invasive approaches [ 5 , 8 ]. This has been explained by a smaller surgical field and a more complicated cannulation technique.…”

Minimally invasive approach for congenital cardiac defects: reply

“…In reply to the letter of Dr Nagarajan Muthialu 1 regarding our recent paper: 2 we profusely appreciate Dr Muthialu’s opinion and valued comments. We wish to state that we do not use intraoperative transesophageal echocardiography for atrial septal defect closure on a regular basis.…”