Comparison of initial outcomes between minimally invasive right minithoracotomy and standard median sternotomy in patients undergoing isolated surgical closures of atrial septal defects.


Background: An atrial septal defect (ASD) can be closed via percutaneous approach and with surgical closure using either the standard median sternotomy or a minimally invasive procedure such as minithoracotmy. In this study, we evaluated the outcomes of using the median sternotomy vs. the right minithoracotomy in isolated closures of ASDs. Methods: This prospective observational study included 44 patients who underwent isolated ASD closures in the department of cardiac surgery at the National Heart Foundation Hospital and Research Institute (NHFH and RI) in Dhaka, Bangladesh, from July 2014 to June 2016. After fulfilling the enrolment criteria, participants were divided into two equal groups of 22 patients. ASD closure was performed on Group 1 using the minimally invasive right minithoracotomy, while the same procedure was performed on Group 2 using the standard median sternotomy. Results: The mean total operative time (in minutes) required was 179.45 ± 26.79 for Group 1 and 154.72 ± 26.15 for Group 2. The mean aortic cross-clamp (ACC) time (in minutes) and cardiopulmonary bypass (CPB) time (in minutes) were significantly increased in Group 1 compared to Group 2 (p=<0.05). Furthermore, the mean ± SD of the length of incision (in centimetres) and duration of endotracheal intubation (in hours) were significantly higher in Group 2 than Group 1 (p<0.001). While the duration of postoperative hospital stays (in days) and pain score (visual analogue scale score) was significantly higher in Group 2 than Group 1. No residual shunt was found in patients of either group. Conclusion: Our findings shows some advantages in group 1 (right minithoracotomy) population including the reduced length of incision, the shorter duration of endotracheal intubation, less postoperative blood loss, fewer transfusion requirements, minimal postoperative pain and the shorter duration of hospital stay. In addition, patients in Group 1 reported smaller scars, as expected, which contributes to better overall patient satisfaction.

Atrial septal defects (ASDs) are one of the most common congenital anomalies. While a small variety of ASDs may close naturally, many necessitate intervention. Percutaneous closure using the Amplatzer device is possible for secundum ASDs, which retain a sufficient rim of tissue around the defect. Conversely, the surgical closure of ASD is traditionally accomplished through a median sternotomy, cardiopulmonary bypass (CPB) and cardioplegic arrest of the heart; however, the unpleasant cosmetic outcome and possible complications of median sternotomy are occasionally distressing to patients.

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