Outcome Of Atrial Septal Defect Occlusion By A Transthoracic Minimally Invasive Sternal Sparing Approach
Sanjay Kumar1, Vladimir Shumaster2.
1Institute of Medical Sciences, Banaras Hindu University, Varanasi, India, 2Yale New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA.
Background The recent development of transcatheter closure technique with Atrial Septal Occluder device provides an alternative therapeutic choice to surgery. However large secundum defects with limited septal margins or fenestrated septum are less suitable for percutaneous closure. We have been operating on these patients with a minimally invasive ASD occlusion technique which is combined the characteristic of both standard surgical ASD closure and intervention closure. We report our initial experience and mid term outcome with Transthoracic Minimally Invasive ASD Occlusion Method: The aim was to evaluate the safety and efficacy of ASD Occlusion by a transthoracic minimally invasive pathway. Nine patients with secundum atrial septal defects were selected for this procedure. We used a new product which including a unique delivery system through a transthoracic pathway. Result: There were 10 men and 15 women with a mean age of 26.4(9.6) years undergone this procedure from 2015 through 2018. All procedures were successful and there were no conversions to median sternotomy. Mean (SD) ASD size was 28.3 ±5.0 mm, including 2 cases for limited rim and one case for fenestrated septal. Mean (SD) procedure time were 54 ±24 minutes, Mean (SD) postoperative hospital stay was 3 (1) days. Mean follow-up reached 20.6 months (median 18, range 14-30 months). Follow up echocardiographic examination found a very small residual shunt in only one patient. The technique has no operative mortality so far. Conclusions: The presented technique provides an alternative procedure for the correction of large secundum ASD, limited rim ASD or fenestrated septum
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