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Secundum atrial septum defect closure in neonates and infants - scrutinizing three different surgical approaches closely
Markus Liebrich1, Anita Narr1, Brigitte Stäbler1, Alexander Horke2, Frank Uhlemann3, Michael Scheid1, Ioannis Tzanavaros1.
1SANA Cardiac Surgery, Stuttgart, Germany, 2University of Hannover, Medical School, Hannover, Germany, 3Department for Pediatric Cardiology, Pulmonology and Intensiv Care Medicine, Olgahospital, Stuttgart, Germany.

OBJECTIVE: Surgical treatment of secundum atrial septal defect (ASD) in neonates and infants represents a standard procedure with very low morbidity and mortality. Variability in operative management of this lesion exists among surgeons. This study sought to compare the safety, efficacy and clinical outcome of three different surgical approaches.
METHODS: Between 05/2009-04/2015, 77 neonates and infants underwent surgical ASD closure. In 27 patients (mean age 3.4±1.8 years) aortic x-clamping (AXC), cardioplegia and full sternotomy was used (group A), in 21 patients (mean age 3.1±2.1 years) AXC, ventricular fibrillation and full sternotomy were performed (group B), and 29 patients (mean age 3.8±2.5 years) were operated via ventricular fibrillation and lower partial sternotomy (group C). In all 3 groups, ascending aortic cannulation was performed to establish cardiopulmonary bypass.
RESULTS: 30-day and overall mortality was zero in group A, B, and C, respectively. There were no severe intraoperative complications, or conversion to full sternotomy in group C. Follow-up was 100 % complete (2.4±1.8 years). Mean operation time and extracorporeal circulation time were significantly shorter in group C (p=0.001) (group A 142±19/57±16 min, group B 123±22/50±17 min, and group C 118±14/41±11 min). Direct ASD closure was carried out in 89% (group A), 85% (group B), and 81% (group C), respectively. Blood transfusion requirement was lower in group C (p<0.05). There were no significant differences between group A, B, and C referring postoperative cardiac biomarker elevation, ventilation time, wound healing, intensive care unit/hospital stay. ASD closure rate was 100%. During follow-up, no redo surgery had to be performed.
CONCLUSIONS: Secundum ASD closure can be performed safely and effectively independent of the surgical approach used without impairment of perioperative and clinical outcome.

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