Atrial septal defect minimally invasive repair

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Ostium Secundum Atrial Septal Defect
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. [2]; Cafer Zorkun, M.D., Ph.D. [3] Assistant Editor(s)-In-Chief: Kristin Feeney, B.S. [4]

Overview

Minimally invasive repair of atrial septal defect has been shown to be as successful as the conventional sternotomy. Although they have not been associated with reduced morbidity and mortality rates, they have been proven to have the advantage of being less invasive, less post-surgical complications, decreased hospital stay, and more cosmetic benefits.

Minimally Invasive Repair

Minimally Invasive Approach to Atrial Septal Defect/ Mini-Thoracotomy

Steps in the Surgery

• Incision made through the right side of the chest.
• Patient put on heart-lung bypass machine.
• Tubes placed in the main artery and vein of the right leg.
• The heart stopped during operation.
• Right atrium opened and atrial septal defect exposed.
• Defect repaired.
• Heart closed and restarted.
• Heart-lung bypass is discontinued.

Types of Incision

• Upper hemisteronomy
• Right parasternal
• Right submammary bikini line (for females)
• Limited median sternotomy (for males)
• Transxiphoid sternotomy (for children or young adults)

It is advised that an anterolateral approach only be used in adults as it may damage prepubescent girls during development of breast tissue.

Advantages

• Less invasive
• Reduced hospital stay
• Faster recovery and healing of wound due to reduced size of incision
• No or minimal activity restrictions post-surgery
• Reduced rate of wound infection

Trial Supportive Data

Studies done on 68 patients (39 conventional sternotomy, 29 minimally invasive ASD closure) to compare the safety and efficacy of minimally invasive ASD closure compared to the conventional sternotomy approach (CSA) found no statistically significant difference in morbidity and mortality. However, a significant difference in postoperative length of stay was seen. Thus, minimally invasive ASD closure (MIC) was found to be as effective as conventional sternotomy approach (CSA) with the advantage of decreased hospital stay .