Surgical alternative – the closure of heart septal defects via less invasive approaches
Virgilijus Tarutis, Virgilijus Lebetkevičius, Vytautas Sirvydis
Seminars in Cardiovascular Medicine 2009; 15: 3

Objectives: 1. To evaluate the less invasive surgical atrial septal defect (ASD) and ventricular septal defect (VSD) closure risk and complications and to compare them with standard median sternotomy. 2. To specify and refine the operative technique of less invasive congenital heart defects surgery.
Design and Methods: A retrospective evaluation of patients operated on during the period from 1998 to 2004 for atrial or ventricular septal defects through a limited approach was performed. 172 patients underwent ASD surgical closure through limited approaches: partial median sternotomy, right anterolateral minithoracotomy and right posterolateral minithoracotomy. Within the same period, 107 patients underwent ASD closure through conventional full length median sternotomy. 11 patients underwent VSD closure through a limited access and 59 patients – through full length sternotomy.
Results: In order to evaluate the less invasive surgical ASD and VSD closure risk some operative and postoperative variables were compared: the operation time, the cardiopulmonary bypass time and temperature, the heart fibrillation time, the aortic cross clamping time, the time of extubation after the completion of the surgical procedure, the amount of postoperative drainage, the duration of intensive care unit stay, the duration of postoperative stay in hospital. Operative variables were similar and within acceptable limits in the less invasive groups. Postoperative pulmonary morbidity was more common in the minithoracotomy groups. We had a significant residual shunting in 1 case after ASD closure through a minithoracotomy approach.
Conclusions: The risk of less invasive ASD and VSD closure does not differ from the standard median sternotomy surgery risk. Less invasive approach techniques used in our centre enabled the accomplishment of heart septal defects surgery with a conventional instrumentation set.

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