Right anterolateral minithoracotomy versus median sternotomy in atrial septal defects closure .

Abstract

Background: Over the years, surgeons have used a midline sternotomy to repair atrial septal defects (ASD) with good long-term outcomes but unsatisfactory cosmosis.Because of this, less intrusive surgical procedures are employed to lessen surgical trauma and improve the final cosmetic outcome.Aim of the study: to assess ASDs repair using right-anterolateral minithoracotomy (RALT) versus median sternotomy in terms of surgical outcomes.Patients and Methods: Our study was prospective, comparative, nonrandomized ,non-blinded study that carried out at our institution between June 2016 and October 2018. It included forty surgical candidates who had isolated ostium secondum ASDs; patients were allocated to either group I (RALT group) (n=20),or group II (conventional sternotomy) (n=20). Results: before surgeries, demographic and echocardiographic data were comparable in both groups except for more female patients(80%) in group I(p-value=0.022) and more patients with low body surface area in group II(p-value=0.002).Group II had considerably shorter total bypass time than group I(p-value=0.004).After surgeries, data were identical in both groups regarding ICU and total hospital stay, chest tube drainage,and amount of blood transfusion.However,group I had significantly shorter mechanical ventilation time(p-value=0.002) and smaller length of wound (p <0.001).Wound infection rate was substantially higher in sternotomy group(p-value=0.035).Patient satisfaction was higher in minithoracotomy group(90%) than in sternotomy group(60%).No cases required conversion to sternotomy in group I. Neither residual defects nor mortality were encountered in both groups. Conclusion: Right anterolateral minithoracotomy approach is safe, effective,cosmetic, less traumatic, and saving resources.