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Clinical Outcomes of Thoracoscopic Asd Closure versus Conventional Median Sternotomy
Ikromzhon Mukhamedov, Seitkhan Joshibayev, Kristina Kapussidi
Research-Clinical Center for Cardiac Surgery and Transplantology, Taraz, Kazakhstan

BACKGROUND: Comparison of the results of closure of the atrial septal defect using thoracoscopic and median approaches
METHODS: Between 2012 and 2019, 173 patients with atrial septal defects were divided into two groups: thoracoscopic group (n-93) and conventional median sternotomy group (n-80). In the thoracoscopic group, all patients underwent total endoscopic procedures with peripheral cardiopulmonary bypass, whereas for the conventional group, all patients were operated using conventional median sternotomy approach. Both ASD closure techniques were performed on beating heart. The average age of patients in thoracoscopic group was 32,716,7 years, in conventional group was 29,816,3 years
RESULTS: ASD closure was successful and there were no in-hospital mortality and major complications. The total duration of operation in thoracoscopic group was 238,8240,74 minutes and in conventional group 212,3146,67 minutes (p<0,05). CPB time were 59,0118,27 vs. 39,1519,92min (p<0,05), duration of intensive care stay was 15,193,18 vs. 23,647,27 hrs (p <0,05), mechanical ventilation time were 170,7103,29 vs 235,56112,33 minutes (p<0,05), whereas volumes of operational bleeding were 92,8547,42vs 214,5651,6ml (p<0,05) and duration of post-operative hospital stay were 6,061,1 vs. 9,042,1 days (p <0,05) in thoracoscopic and conventional group, respectively. Follow-up transthoracic echocardiography before discharge showed no residual shunts in all patients. It should be noted that the postoperative scar in thoracoscopic group was significantly smaller in its size (p<0.05) than one in the conventional group (6.06 1.1 and 17.4 3.9 cm, respectively), which is especially important from the aesthetic side of the intervention
CONCLUSIONS:The data obtained indicate the successful use of two approaches, however, in the group where thoracoscopic correction was performed, duration of stay in the ICU and in the hospital, volume of blood loss, the need for blood transfusion, and the length of the skin incision were significantly lower than in the group with the median sternotomy access


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