Minimally Invasive Surgery Treatment Of Atrial Septal Defect: Early Outcomes From A Single Centre Experience.
Vincenzo Caruso, Inderpaul Birdi.
Basildon Hospital Cardiothoracic Centre, Basildon, United Kingdom.
OBJECTIVE: To evaluate the immediate and early outcomes after minimally invasive treatment of Atrial Septal Defect (ASD) and to compare this approach with a standard full sternotomy.
METHODS: 14 consecutive patients (mean age 50.07 ± 15.95 years, mean logistic Euroscore 2.65 ± 2.06) underwent minimally invasive surgery for the repair of ASD; in 2 of those patients, a mitral valve repair (MVR) was performed. The data were compared with a subgroup of 11 patients underwent ASD ± MVR with a standard full sternotomy approach (mean age 53.27 ± 15.83 years, mean logistic Euroscore 2.64 ± 0.96).
RESULTS: Minimally invasive repair of ASD was successfully achieved in all patients (success rate, 100%). In-hospital mortality was 0%. The most common ASD was a type ostium secundum (n=24, 96%), while a type ostium primum was observed in only one patient (4%). The mean aortic cross clamping time of minimally invasive procedures was 70.21 ± 15.92 minutes, significantly lower for isolated ASD, 68.83 ± 13.89 minutes, than for ASD plus MVR, 78.5 ± 31.81 minute, p<0.05. The cohort of patients underwent mini-ASD closure presented with a bigger ASD (22.43 ± 11.06 mm vs 19.27 ± 8.52 mm) with a major right ventricular dysfunction (QP/QS: 2.24 ± 0.62 vs 1.87 ± 0.56). Minimally invasive treatment was associated with a shorter hospital stay than full sternotomy approach, 5.71± 1.2 vs 6.45 ± 2.7 days, but this difference was not significantly. Freedom from residual ASD, stroke and reoperation for bleeding was 100% in all the cases.
CONCLUSIONS: Minimally Invasive repair of ASD is associated with satisfactory immediate and early outcomes in high-risk patients (size of ASD and right ventricular impairment) and appear to provide satisfactory clinical and hemodynamic results. It is an easily reproducible technique with a very low incidence of failure.
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