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ASD Surgical Repair Using a Right Midaxillary Minithoracotomy and Ventricular Fibrillation: Experience in Chidren Under 15 kg
Alexey N. Arkhipov, MD, PhD, Alexander Y. Omelchenko, MD, PhD, Yuriy N. Gorbatykh, MD, PhD, Alexey V. Zubritskiy, MD, Timur S. Khapaev, MD, PhD, Gregory S. Zaitsev, MD, Alexander V. Bogachev-Prokophiev, MD, PhD, Alexander M. Karaskov, MD, PhD.
Academician E.N.Meshalkin State Research Institute of Circulation Pathology, Novosibirsk, Russian Federation.
OBJECTIVE: The era of minimally invasive cardiac surgery has expanded the list of alternative surgical approaches for secundum atrial septal defect (ASD) repair. Currently these procedures are commonly used for patients with weight above 15-30 kg. Safety and efficiency of this procedure for children less than 15 kg is still unclear.
METHODS: From July 2012 to October 2013, 67 pediatric patients under 15 kg of weight underwent surgical ASD closure using a right midaxillary minithoracotomy and ventricular fibrillation. 65 patients had an isolated ASD with contraindications for catheter device closure. 2 patients had a sinus venosus ASD with partial anomalous pulmonary veins connection. Our surgical approach is a right midaxillar thoracotomy in 4th intercostal space with skin incision 3-4 cm. In all patients direct cannulation was performed for cardiopulmonary bypass.
RESULTS: Mean age was 24,7 ± 9,8 months (range, 7-60 months) and mean body weight was 11,3 ± 1,9 kg (range, 6,7-15 kg), 23 patients (34%) were under 10 kg. Direct closure was carried out in 19 patients, the remaining 48 had pericardial patch closure. Average cardiopulmonary bypass time was 28,8 ± 10,2 minutes (range, 12-57 minutes). Closure of the defect was carried out during ventricular fibrillation in all patients with the mean duration 13,0 ± 9,6 minutes (range, 5-27 minutes). No patient required conversion to a sternotomy or incision elnlargement to complete the repair. There was no mortality, bleeding or wound complications. Non-significant residual shunts have been revealed in 3 children. All patients were in good clinical condition with improved functional status at discharge from the hospital.
CONCLUSIONS: Surgical ASD repair in children under 15 kg using a right midaxillary minithoracotomy and ventricular fibrillation is safe and efficient. More over the procedure is associated with the low rate of complications and better cosmetic results.
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