Port-access minimally invasive surgery for atrial septal defects: a 10-year single-center experience in 166 patients.

Abstract

OBJECTIVE:

We assessed the surgical results and the benefits to the patient of a minimally invasive surgical approach for atrial septal defects.

METHODS:

Between May 1998 and May 2008, 166 patients (median age, 44 years) had surgery for atrial septal defects in our institution. Of these patients, 118 (71%) had a patent foramen ovale (associated with atrial septal aneurysm in 48 cases), 33 (20%) had a wide ostium secundum defect, 6 (3.6%) had an ostium primum defect, 6 (3.6%) had a sinus venosus defect with abnormal pulmonary vein connection, and 1 (0.6%) had a coronary sinus defect. In 2 cases (1.2%) patients were referred to our department for surgical correction after failure of interventional occluder placement. All patients were operated on via a right minithoracotomy (mean incision, 5.5 + or - 1 cm) in the fourth intercostal space and under cardiopulmonary bypass.

RESULTS:

The HeartPort access system was used in 106 patients (64%), with an endoaortic clamp (central kit in 50 cases and peripheral kit in 56). In the remaining patients (36%), we preferred the Portaclamp system (37 cases) or the Chitwood clamp (23 cases). Average crossclamp time was 38.4 + or - 22.2 minutes with a mean cardiopulmonary bypass time of 64.9 + or - 34.5 minutes. There was no conversion in classic sternotomy. There were no early or late hospital deaths. Surgical revision was performed in 6 patients for bleeding from the thoracic wall. The mean hospital stay was 5.8 days. At 51 months mean follow-up, 4 patients died of non-cardiac-related causes.

CONCLUSIONS:

Port-access minimally invasive surgery for atrial septal defects is a safe, less-invasive, reproducible, and cosmetic operation, providing an excellent outcome and an effective correction, and could be now considered the standard approach for this type of patient.

• Authors: Nicola Vistarini, Marco Aiello, Gabriella Mattiucci, Alessia Alloni, Barbara Cattadori, Carmine Tinelli, Carlo Pellegrini, Andrea Maria D'Armini, Mario Viganò
• Journal: The Journal of thoracic and cardiovascular surgery (J Thorac Cardiovasc Surg) Vol. 139 Issue 1 Pg. 139-45 (Jan 2010) ISSN: 1097-685X [Electronic] United States
• PMID: 19709683 (Publication Type: Journal Article)
• Copyright: Copyright 2010 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Anesthesia, General (methods)
• Cardiopulmonary Bypass
• Child
• Child, Preschool
• Female
• Follow-Up Studies
• Heart Septal Defects, Atrial (mortality, surgery)
• Humans
• Male
• Middle Aged
• Minimally Invasive Surgical Procedures (methods)
• Postoperative Complications
• Treatment Outcome