MAT Closure For Atrial Septal Defect On Perfused Beating Hearts
zengshan ma, Sr..
Shandong Unversity, Ji'nan, China.
OBJECTIVES-Thoracoscopy assisted minimally invasive closure for atrial septal defect (ASD) through a small right thoracotomy is a novel technique for surgical ASD, which is increasingly adopted around the world. This study aims to describe the characteristics of MA'S tri-port chest thoracoscopic cardiac surgery Technique (MAT) and mid-term outcomes of a series of closure for ASD to identify areas for improvement. METHODS-MAT invented by Author's team in 2009, is totally thoracoscopic heart surgery conducted through three ports of the right chest wall. MAT belongs to the field of microsurgery, and has many advantages with small surgical trauma, fine operation and simple process. Starting from Jun. 2009 to Oct. 2018, MAT has been successfully performed in 2166 cases, including 697 treated patients (8-54 years, mean 19.9 ± 9.5) undergoing ASD closure without the aid of a robotic surgical system, another 650 patients undergoing ASD closure after MAT performed on beating hearts. Additional 72 patients undergoing totally thoracoscopic ASD closure on cardioplegic arrested hearts were selected as a control. Cardiopulmonary bypass was achieved peripherally. The aorta was not cross-clamped in the study group, but it was cross-clamped in the control group. RESULTS-ASD closure was successful in all study and control group patients without in-hospital mortality or major complications. Comparing to the control group, the study group has shorter total duration of operation (75 ± 5 vs. 91 ± 4 min, P = 0.012), shorter CPB time (33 ± 5 vs. 45 ± 4 min, P = 0.001), shorter intensive care stay (6.0 ± 3.0 vs. 19.0 ± 4.1 h, P = 0.003) and shorter post-operative hospital stay (4.1 ± 0.7 vs. 5.1 ± 1.0 days, P = 0.045). However, there was no statistically significant difference in the proportion of patients requiring in-operation blood transfusion between study group and control group (24.0 vs. 33.2%, P = 0.226). Follow-up transthoracic echocardiography results at Day 5 and Month 3 showed that residual shunts in study group or control group patients, and all[P1] patient recovery times varied broadly from 3 month to 9 years. CONCLUSIONS-MAT closures of ASD on perfused beating hearts are feasible and safe. These procedures are associated with a shorter operation time and a shorter hospital stay than in surgeries on cardioplegic arrested hearts. MAT undergoing ASD closure on beating heart is an improvement of minimally invasive cardiac surgery.
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