Standard median sternotomy versus minimally invasive approach for atrial septal defect closure in adults

Résumé

Background Atrial septal defects (ASDs) in adults and adolescents are not uncommon. Surgical ASD closure through a standard median sternotomy (SMS) has become less attractive approach in favor of minimally invasive techniques, especially in young female patients. Objective The aim was to compare early postoperative outcomes of surgically closed secundum ASDs through a SMS approach versus minimally invasive right anterolateral thoracotomy (MIRAT) approach in adults. Patients and methods The authors prospectively studied 60 adult patients who had their secundum ASD anomalies surgically closed at National Heart Institute between the period of September 2020 and February 2022. A total of 30 patients had their ASD closed through a SMS approach, whereas the other 30 patients underwent MIRAT approach. Early postoperative results were collected and compared with each other. Results There was no mortalities throughout the study, male : female ratio was similar in both groups with dominance of female patients, and patients in the minimally invasive group was younger (28.10±8.73 years). The minimally invasive group had a significantly longer cardiopulmonary bypass time (106.53±7.60 vs. 63.40±4.68 min), longer cross-clamp time (84.06±9.03 vs. 51.33±4.55 min), and longer total operation time (158.13±13.76 vs. 121.80±7.15 min) than the standard group. The mechanical ventilation time (16.80±4.07 vs. 14.70±2.40 h), ICU stay (1.33±0.46 vs. 1.13±0.29 days) and total hospital stay (8.16±1.74 vs. 6.33±1.09 days) were significantly longer in the standard group compared with the minimally invasive group. Conclusion Surgical ASD closure via a MIRAT approach is safe and comparable to standard techniques.