Wadhawa V, Doshi C, Hinduja M, Garg P, Patel K, Mishra A, Shah P. Anterior Minithoracotomy: a Safe Approach for Surgical ASD Closure & ASD Device Retrieval.
Braz J Cardiovasc Surg 2017;
32:270-275. [PMID:
28977198 PMCID:
PMC5613724 DOI:
10.21470/1678-9741-2017-0024]
[Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 04/13/2017] [Indexed: 11/23/2022] Open
Abstract
Objective
Midline sternotomy is the preferred approach for device migration following
transcatheter device closure of ostium secundum atrial
septal defect. Results of patients operated for device migration were
retrospectively reviewed after transcatheter closure of atrial septal
defect.
Methods
Among the 643 patients who underwent atrial septal defect with closure
device, 15 (2.3%) patients were referred for device retrieval and surgical
closure of atrial septal defect. Twelve patients underwent device retrieval
and surgical closure of atrial septal defect through right antero-lateral
minithoracotomy with femoral cannulation. Three patients were operated
through midline sternotomy.
Results
Twelve patients operated through minithoracotomy did not require conversion
to sternotomy. Due to device migration to site of difficult access through
thoracotomy, cardiac tamponade and hemodynamic instability, respectively,
three patients were operated through midline sternotomy. Mean aortic
cross-clamp time and cardiopulmonary bypass time were 28.1±17.7 and
58.3±20.4 minutes, respectively. No patient had surgical complication
or mortality. Mean intensive care unit and hospital stay were 1.6±0.5
days and 7.1±2.2 days, respectively. Postoperative echocardiography
confirmed absence of any residual defect and ventricular dysfunction. In a
mean follow-up period of six months, no mortality was observed. All patients
were in New York Heart Association class I without wound or vascular
complication.
Conclusion
Minithoracotomy with femoral cannulation for cardiopulmonary bypass is a
safe-approach for selected group of patients with device migration following
transcatheter device closure of atrial septal defect without increasing the
risk of cardiac, vascular or neurological complications and with good
cosmetic and surgical results.
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