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

Abstract

ObjectiveMidline 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.MethodsAmong 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.ResultsTwelve 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.ConclusionMinithoracotomy 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.

Right Minithoracotomy: Is It Going to Be the Routine Approach for Secundumasd Surgical Closure?

“…Other studies showed that bypass time was similar comparing minimal invasive approach to sternotomy , with clamp time slightly higher in minimal invasive one than sternotomy. (65±23 Vs 62±22 minutes) (1) .…”

“…Vent was applied through upper superior pulmonary vein. Tricuspid valve and ASD exposure was done through a hockey stick right atriotomy perpendicular to the septum and extended towards the right atrial appendage figure (1). Nylone tape was applied around the venous cannula retracting it away from the field of the ASD opening figure (2).…”

“…Only Chitwood type transthoracic aorticclamp was important to replace the conventional one. [1] Other studies reported usage of an endoaortic balloon clamp into the proximal ascending aorta. [5]…”

“…Moreover, it has a reported rate of complications of 1.1-3.5% and some of these complications may be fatal and needs urgent surgery as migration. Minimal invasive congenital heart surgery, especially elective ones, is gaining more popularity due to its better cosmetic appearance, no sternal complications and shorter hospital stay [1] .…”