Aim: Concerns remain that minimally invasive atrial septal defect (ASD) repair may compromise patient outcomes. We compared clinical outcomes of adult patients undergoing ASD repair via a minimally invasive thoracotomy approach versus a “gold standard” sternotomy.
Material and Methods: We retrospectively reviewed the clinical outcomes of 166 consecutive patients who underwent ASD patch repair at our institution between 2010 and 2016. We compared inhospital/30-day mortality, postoperative complications, required analgesic therapy, length of stay in hospital and in the intensive care unit and blood product requirements between patients who underwent right Minimally invasive thoracotomy (MT) and those who underwent conventional sternotomy.
Results: During the study period, 166 consecutive patients underwent ASD repair at our institution: 72 (age 29.97±3.84 yr, 62.5% women) in the MT group and 94 (age 35.93±14.78 yr, 66.6% women) in the sternotomy group. All of the patients were diagnosed with secundum type ASD. There were no statistically significant differences in cardiopulmonary bypass time (p=0.11), aortic cross-clamp time (p = 0.10), and total operation time (p=0.10) between the two groups. There were no significant differences in any postoperative complications or blood product requirements. Compared with the sternotomy group, patients who received thoracotomy were mobilized earlier, required less analgesic therapy, and had a shorter intensive care unit stay and hospitalization. Mean intensive care unit (MT 1.0 ± 0 d ,v.sternotomy 1.27±0.8 d, p = 0.17) and hospital length of stays (MT 4.93±1.07 v.sternotomy 5.54±1.07 d, p = 0.17). No patients in the MT group suffered retrograde aortic dissection or leg ischemia.
Conclusion: Repair of ostium secundum type ASD can be performed safely via Minimally invasive thoracotomy approach with similar outcomes as sternotomy. Our results suggest that thoracotomy may be an alternative approach in closure of atrial septal defects due to its favorable cosmetic results and a more rapid patient recovery.
Key words: Congenital heart disease, atrial septal defect, surgery, minimally invasive
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