Transareolar Video-assisted Approach To The Atrial Septal Defect And Tricuspid Valve
Tadashi Kitamura, Shinzo Torii, Koichi Sughimoto, Kensuke Kobayashi, Mamika Motokawa, Miyuki Shibata, Takamichi Inoue, Haruna Araki, Kagami Miyaji.
Kitasato University School of Medicine, Sagamihara, Japan.
OBJECTIVE: This study aimed to review the initial outcomes of atrial septal defect (ASD) closure and tricuspid annuloplasty (TAP) using transareolar approach.
METHODS: Retrospective review of the impatient records. Operative technique: 3D-CT is used to determine the approach and the intercostal space to enter. Under general anesthesia with double-lumen intubation, the right internal jugular vein is punctured for superior vena caval drainage, and the right femoral artery and vein are cannulated under transesophageal echocardiography guidance. Two-fifths of the perimeter of either the superior or inferior margin of the areola is incised according to the anatomy and the chest is entered through transareolar mini-thoracotomy. Cardiopulmonary bypass is established and a videoscope is inserted through a port posterior to the wound. After pericardiotomy, the superior and inferior vena cavae are snagged, the right upper pulmonary vein is cannulated for left atrial vent and a needle is placed for antegrade cardioplegia with endoscopic assistance. The aorta is cross-clamped with transthoracic forceps followed by antegrade cardioplegia and right atriotomy. The atrial septal defect is closed using a 0.4-mm ePTFE patch under direct vision, and tricuspid annuloplasty using a rigid ring is performed with endoscopic assistance. A temporary pacing lead is placed on the diaphragmatic surface of the right ventricle and the aorta is declamped. Cardiopulmonary bypass is discontinued and, after confirming hemostasis, the chest is closed with an intercostal analgesic catheter.
RESULTS: Five cases were identified from January to December 2016. Four were female and mean age was 47 years (range: 20-68). Four underwent ASD closure and TAP, and one underwent ASD closure. All operations were safely performed with endoscopic assistance. Blood transfusion was not performed in any case.
CONCLUSIONS: Transareolar approach is feasible and useful in ASD closure and TAP.
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