Comparison of 3 Different Incisions Used for Atrial-Septal Defect Closure

Authors

  • Murat Basaran
  • Ali Kocailik
  • Cihan Ozbek
  • Alper Ucak
  • Eylul Kafali
  • Melih Us

DOI:

https://doi.org/10.1532/HSF98.20081060

Abstract

Background: Surgical closure of atrial-septal defects is now associated with low morbidity and mortality rates. We assessed surgical, cosmetic, and psychological results of 3 different surgical approaches to atrial-septal defect repair.

Methods: Study participants were 82 patients who underwent surgery for atrial-septal defect. Mean age was 21 ± 8 years, and the female:male ratio was 23:59. Patients were divided into 3 groups according to the incision used; group 1 (n = 26), partial lower sternotomy; group 2 (n = 34), right anterolateral thoracotomy via a submammary incision, and group 3 (n = 22), conventional median sternotomy.

Results: There was no operative or late mortality. No significant differences between groups were associated with the surgical technique used. Direct closure was the procedure of choice performed in 53 patients (64.6%). In the remaining patients the repair was performed with a pericardial patch (29 patients, 35.4%). One patient in group 1 required conversion to median sternotomy because transoesophageal echocardiography performed at the operating theater revealed a partial anomalous pulmonary venous connection of right pulmonary veins to the inferior vena cava. This patient was excluded from the study group. All patients were symptom free postoperatively, and control echocardiography revealed a trivial shunt in only 1 patient, with a Qp:Qs ratio of 1.3. Rhythm abnormalities, including atrioventricular block, atrial fibrillation, and flutter, were observed in 7 patients but were found to be unrelated to the surgical incision (P = .3). Cardiopulmonary bypass, cross-clamp, and operative times were longer with minimally invasive approaches; but these differences were not statistically significant. Intensive care unit and hospital stay periods were significantly shorter in groups 1 and 2. During the postoperative follow-up period, patients in groups 1 and 2 showed superior results in satisfaction with their cosmetic outcomes.

Conclusions: With the development of minimally invasive techniques that yield surgical results comparable to those of standard techniques, surgeons have changed their focus from survival to cosmetic and psychological outcomes, especially in the repair of simple cardiac defects. Operations performed via limited skin incisions are surgically safe and provide superior cosmetic and psychological results.

References

Abdel-Rahman U, Wimmer-Greinecker G, Matheis G, et al. 2001. Correction of simple congenital heart defects in infants and children through a minithoracotomy. Ann Thorac Surg72:1645-9.nAk K, Aybek T, Wimmer-Greinecker G, et al. 2007. Evolution of surgical techniques for atrial septal defect repair in adults: a 10-year singleinstitution experience. J Thorac Cardiovasc Surg134:757-64.nBarbero-Marcial M, Tanamati C, Jatene MB, Atik E, Jatene AD. 1998. Transxiphoid approach without median sternotomy for the repair of atrial septal defects. Ann Thorac Surg65:771-4.nBichell DP, Geva T, Bacha EA, Mayer JE, Jonas RA, del Nido PJ. 2000. Minimal access approach for the repair of atrial septal defect: the initial 135 patients. Ann Thorac Surg70:115-8.nDäbritz S, Sachweh J, Walter M, Messmer BJ. 1999. Closure of atrial septal defects via limited right anterolateral thoracotomy as a minimal invasive approach in female patients. Eur J Cardiothorac Surg15:18-23.nDoll N, Walther T, Falk V, et al. 2003. Secundum ASD closure using a right lateral minithoracotomy: five-year experience in 122 patients. Ann Thorac Surg75:1527-30.nGatzoulis MA, Redington AN, Somerville J, Shore DF. 1996. Should atrial septal defects in adults be closed? Ann Thorac Surg61:657-9.nGiamberti A, Mazzera E, Di Chiara L, Ferretti E, Pasquini L, Di Donato RM. 2000. Right submammary minithoracotomy for repair of congenital heart defects. Eur J Cardiothorac Surg18:678-82.nHongxin L, Wenbin G, Lijun S, et al. 2007. Intraoperative device closure of secundum atrial septal defect with a right anterior minithoracotomy in 100 patients. J Thorac Cardiovasc Surg134:946-51.nHorvath KA, Burke RP, Collins JJ Jr, Cohn LH. 1992. Surgical treatment of adult atrial septal defect: early and long-term results. J Am Coll Cardiol20:1156-9.nHouyel L, Petit J, Planché C, et al. 1999. Right postero-lateral thoracotomy for open heart surgery in infants and children. Indications and results. Arch Mal Coeur Vaiss92:641-6.nKonstantinides S, Geibel A, Olschewski M, et al. 1995. A comparison of surgical and medical therapy for atrial septal defect in adults. N Engl J Med333:469-73.nLange R, Schreiber C, Günther T, et al. 2001. Results of biventricular repair of congenital cardiac malformations: definitive corrective surgery? Eur J Cardiothorac Surg20:1207-13.nLiang T, XiangJun Z, XiaoJing M, Yun L, Leng CY. 2006. New minimally invasive technique to occlude secundum atrial septal defect in 53 patients. Ann Thorac Surg81:1417-9.nMassetti M, Babatasi G, Rossi A, et al. 1996. Operation for atrial septal defect through a right anterolateral thoracotomy: current outcome. Ann Thorac Surg62:1100-3.nMassetti M, Nataf P, Babatasi G, Khayat A. 1999. Cosmetic aspects in minimally invasive cardiac surgery. Eur J Cardiothorac Surg Suppl2:S73-5.nMishaly D, Ghosh P, Preisman S. 2008. Minimally invasive congenital cardiac surgery through right anterior minithoracotomy approach. Ann Thorac Surg85:831-5.nOgus H, Selimoglu O, Basaran M, et al. 2007. Effects of intrapleural analgesia on pulmonary function and postoperative pain in patients with chronic obstructive pulmonary disease undergoing coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth21:816-9.nRyan WH, Cheirif J, Dewey TM, Prince SL, Mack MJ. 2003. Safety and efficacy of minimally invasive atrial septal defect closure. Ann Thorac Surg75:1532-4.nSchreiber C, Bleiziffer S, Kostolny M, et al. 2005. Minimally invasive midaxillary muscle sparing thoracotomy for atrial septal defect closure in prepubescent patients. Ann Thorac Surg80:673-6.n

Published

2008-10-22

How to Cite

Basaran, M., Kocailik, A., Ozbek, C., Ucak, A., Kafali, E., & Us, M. (2008). Comparison of 3 Different Incisions Used for Atrial-Septal Defect Closure. The Heart Surgery Forum, 11(5), E290-E294. https://doi.org/10.1532/HSF98.20081060

Issue

Section

Articles

Most read articles by the same author(s)

<< < 1 2