<![CDATA[<B>Comparative study between inverted "L" mini-sternotomy and complete sternotomy for the surgical treatment of the atrial septal defect (ASD)</B>]]>

Abstract

Objective: To compare the results obtained from two distinct surgical approaches in patients undergoing surgical correction of an atrial septal defect (ASD). Method: The study series consisted of 20 patients, with a mean age of 24.1 ± ± ± ± ± 14.2 years, distributed in two groups. In group A, 10 patients (80% female, with a mean age of 20.9 ± ± ± ± ± 12.0 years) underwent surgical correction of ASD through a complete sternotomy. In group B, 10 patients (80% of females, with a mean age of 27.4 ± ± ± ± ± 16.1 years) were operated through an inverted 'L' ministernotomy. A p-value < 0.05 was considered statistically significant. Results: There was no statistical significance for demographics variables, duration of surgery, cardiopulmonary bypass time, clamping time, amount of cardioplegia administered, thoracic drainage, ICU stay, duration of mechanical ventilatory support, amount of blood and its components transfused, arrhythmia or pacemaker usage. There was statistical significance (p= 0.00001) between incision size performed by complete sternotomy (group A) and inverted 'L' mini-sternotomy (group B), with mean incision sizes of 15.7 ± ± ± ± ± 0.8 and 6.8 ± ± ± ± ± 0.6 cm, respectively. There was a difference in the mean hospital stay between the groups but without statistical significance (7.5 ± 1.6 days in group A and 6.4 ± 1.3 days in group B, with a p-value = 0.12). There was no mortality or complications reported in either surgical approach. Conclusion: There was no difference in the operative and postoperative periods between the techniques that were performed except for the incision size, with a better cosmetic result seen with the inverted 'L' ministernotomy.

Lower Ministernotomy and Fast Tracking for Atrial Septal Defect

“…It is difficult when the heart is enlarged because of poor function or chronic arterial hypertension, in obese or deep-chested patients, and those with diffuse coronary disease. 10 In contrast to our findings, Sampaio and colleagues 9 reported longer durations of surgery, cardiopulmonary bypass, and ischemia with a ministernotomy, possibly because the procedures were performed by more than one surgeon and involved learning curves.…”

“…This problem can be avoided by first removing the cannula and placing a hemostatic suture with the atrium partially empty. 9 We believe that this maneuver is essential to avoid postoperative bleeding. The size of the incision and the sternal division can be easily extended for better exposure if necessary; however, a 4-cm incision and division of the lower half of the sternum was sufficient in most cases.…”

“…6 The duration of surgery, aortic clamping, and cardiopulmonary bypass vary according to the complexity of the interatrial shunt, the necessity for other procedures, and use of a pericardial patch. 9 The small size of the incision makes suture placement more dependent on needle angles, and the rhythm of operating is more difficult to obtain than with the standard midline sternotomy incision. It is difficult when the heart is enlarged because of poor function or chronic arterial hypertension, in obese or deep-chested patients, and those with diffuse coronary disease.…”

“…The skin incision was significantly shorter in our series compared to some other reports, but similar to that described by Sampaio and colleagues. 9 Smaller incisions are becoming an expectation of patients and seem to provide accelerated physical recovery. The ideal minimally invasive incision should permit access to all areas of the heart, require a minimum of specialized equipment, and provide the patient with a rapid return to normal activities.…”