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Small is beautiful - but is it also better? An Evaluation of Different Minimally Invasive Repair Techniques of Atrial Septal Defects
Ioannis Tzanavaros1, Constanze Merz2, Anita Narr1, Brigitte Stäbler1, Alexander Horke2, Nicolas Doll1, Michael Scheid1, Markus Liebrich3.
1SANA Cardiac Surgery, Stuttgart, Germany, 2University of Hannover, Medical School, Hannover, Germany, 3SANA Congenital Cardiac Surgery, Stuttgart, Germany.

OBJECTIVE: Minimally invasive techniques evolve in the repair of simple congenital heart defects.
We evaluated our operative results using simplified operative methods to repair atrial septal defects taking into consideration the safety of the circuit and the effectiveness of the repair.
METHODS: Eighty-two adult patients underwent repair of atrial septal defects through minimal lateral thoracotomy, aortic clamping and cardioplegia (group A, n=51) or minimal lateral thoracotomy and electrically induced fibrillation without aortic manipulation (group B, n=31). The patients were operated at our institution between 2010 and 2015.
RESULTS: The mean age of the cohort was 45 years (17-78 years) with an average weight of 79 kg (42-132 kg). Operation time took 161 minutes on average (72-390 minutes) with an average bypass time of 84 minutes (19-259 minutes). The cohort includes 79 patients with an ostium secundum defects and 3 patients with a sinus venosus defect.
Group A received a single dose or subsequent doses of blood cardioplegia, whereas in group B electrical ventricular fibrillation was induced. Group B showed a significantly shorter operation time (p=0.001) and bypass time (p=0.001) compared to group A. Also postoperative ventilation time was reduced significantly (p=0.001) in group B.
There was no difference between the two groups concerning blood transfusion and hospital stay. In one patient of group A a rest defect was identified in echocardiography postoperatively. In another three patients an occluder implantation was necessary. There were no operative or late deaths.
CONCLUSIONS: Minimally invasive ASD closure gains popularity due to superior cosmetic results combined with excellent repair results. The modification without aortic manipulation reduces the operative and perfusion time providing safety and effectiveness.

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