Anterior Minithoracotomy: a Safe Approach for Surgical ASD Closure & ASD Device Retrieval

Lateral atrial septal defect closure with induced ventricular fibrillation versus cardioplegic arrest

Minimally invasive surgical closure of atrial septal defects is gaining widespread acceptance and can be performed via a right midaxillary thoracotomy. In addition, the procedure can be performed in ischaemic cardiac arrest or fibrillation with a core body temperature between 34°C and 36°C.

OBJECTIVES

We present our single-centre results of paediatric patients who underwent surgical atrial septal defect II closure via lateral thoracotomy.

METHODS

Retrospective analysis. Patients were divided into a cardiac arrest group and a cardiac fibrillation group. All procedures were performed via right midaxillary thoracotomy through a single incision without side ports.

RESULTS

All 37 consecutive patients between March 2019 and August 2022 (median age 3 years; percentile 25th: 2; 75th: 5 years) in both groups were free of mortality and postoperative morbidity such as haemodynamically relevant residual shunt or malignant arrhythmias. Cardiopulmonary bypass time was significantly shorter in the fibrillation group (mean: 34.7 min vs 52.6 min, P = 0.01), and all patients were weaned off the ventilator immediately postoperatively. Length of the intensive care unit stay was not different between the 2 groups. Postoperative hospital stay was significantly longer in patients with cardiac arrest (mean: 5.6 days vs 4.9 days, P = 0.04). Postoperative laboratory parameters did not differ between the 2 groups. All patients were discharged with normal left ventricular function and normalized cardiac enzymes.

CONCLUSIONS

Minimally invasive closure of an atrial septal defect during atrial fibrillation is a safe procedure with results comparable to those of an induced cardiac arrest procedure.

[Surgical treatment of heart valve disease and cardiac tumors via the right-sided minithoracotomy]

OBJECTIVE

To evaluate the early outcomes of surgical treatment of heart valve disease and cardiac tumors via the right-sided minithoracotomy.

MATERIAL AND METHODS

There were 77 interventions via the right-sided minithoracotomy for the period from 2017 to March 2021 (29 men (37.7%) and 48 women (62.3%) aged 50.9±13 years (95% CI 48-53.9)). Heart failure NYHA class III prevailed (45.5%). The following interventions were performed: mitral valve replacement - 32 (41.5%) patients, mitral valve repair - 22 (28.6%) patients, atrial septal defect closure - 13 (16.9%) patients, resection of the left atrial myxoma - 4 (5.2%) patients, atrial septal defect closure + tricuspid valve repair - 2 (2.6%) patients, tricuspid valve replacement - 2 (2.6%) patients, mitral valve repair + atrial septal defect closure - 1 (2.6%) patient, mitral valve repair + atrial septal defect closure + right middle lobectomy - 1 (2.6%) patient.

RESULTS

There were no in-hospital mortality and major cardiac events. Conversion was required in 1 case (1.3%). Enlargement up conventional to thoracotomy was required in 1 case (1.3%). Surgery time was 217 min (Q1-Q3 188-258), cardiopulmonary bypass time - 106 min (Q1-Q3 91-124), aortic cross-clamping time - 82±29 min (95% CI 76-89). Intraoperative blood loss was 500 ml (Q1-Q3 400-600). Mean postoperative hospital-stay was 6.7±1.8 days (95% CI 6.3-7.1).

CONCLUSION

Heart valve surgery and resection of cardiac tumors via the right-sided minithoracotomy is a safe and effective approach to ensure chest stability, fast postoperative recovery and favorable cosmetic result. Surgery time is decreased along the learning curve.