Right Thoracotomy For Atrial Septal Defect Closure In Adults
Abdusalom A. Abdurakhmanov, Saidjalol Tursunov, Shamsiddin Shakarov.
Republic Research Center Of Emergency Medicine, Tashkent, Uzbekistan.
BACKGROUND: Minimally invasive techniques provide good visualization and access. With a number of advantages, these operations are promising and can be performed with a high degree of efficiency and safety. The goal of minimally invasive cardiac surgery is to achieve the best results for the patient with the same quality as through a complete median sternotomy. The purpose of the study was comparative evaluation of atrial septal defect repair in adult patients through anterolateral right thoracotomy and median sternotomy.
METHODS: In this retrospective study 26 patients with atrial septal defect (ASD) operated in Cardiac surgical department at Republican Research Centre of Emergency Medicine were included. Surgical access was provided through right-sided anterolateral mini-thoracotomy (7-8 cm) in the third-fourth intercostal space or through median sternotomy. All patients regarding to the approach were divided into two groups: 1 - anterolateral right thoracotomy - 10 patients (8 (80%) - females; mean age - 35,2±5,5 years); 2- median sternotomy - 16 patients (12(75%) - females; mean age - 34,3±4,5). Cardiopulmonary bypass in with mini-thoracotomy cases was connected using "right common femoral artery - right common femoral vein", superior caval vein was canullated directly. The femoral vessels were cannulated in "open" way. In median-sternotomy cases standard ascending aorta and bicaval canullation was used. In all cases, an atrial septal defect was corrected with an autopericardial patch; The interatrial septum was accessed through the right atrium. RESULTS: The average duration of the operation in the first group was 140.5±49.0 min, the average time of CPB was 40.0±10.3 min, the average aorta cross clamp time was 25.6±5.1 min. The average volume of intraoperative blood loss was 200.0 ± 50.0 ml. In the second group - the duration of the surgery was 130.2±39.0 min, the average time of CPB was 35.0±8.1 min, the average time of aorta cross clamp was 22.6±3.1 min (p≥0,05). In general, an uncomplicated postoperative period was observed in all operated patients. There were no bleedings in the early postoperative period that required reoperation. There were no wound complications on the access side. The average postoperative bed-day was 8.0 ± 2.0 in the case of mini-thoracotomy access, and 10 ± 2.0 in the case of sternotomy access.
CONCLUSIONS: Minimally invasive techniques provides good visualization and allows adequate surgical correction. With a number of advantages, these operations are promising and can be performed with a high degree of efficiency and safety. We consider minimally invasive cardiac surgery as an opportunity to reduce surgical trauma, guaranteeing the patient the quality and safety of a standard approach.
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