Abstract
BackgroundTo compare the short-term safety and efficacy of right anterolateral minithoracotomy (ALMT) and median sternotomy (MS) for the surgical treatment of atrial septal defects (ASDs).MethodsThe PubMed, EMBASE, Web of Science, and Cochrane Library databases were searched for comparative studies focusing on surgical repair of ASDs via ALMT or MS published up to the end of April 27, 2020. We used random-effect or fixed-effect models to obtain pooled estimates.ResultsA total of 7 publications, including 665 patients (ALMT 296 and MS 369), were included. Age (WMD: 1.80 years, 95% CI 0.31–3.29), weight (WMD: − 0.91 kg, 95% CI − 5.57 to 3.75), sex distribution (OR: 1.00, 95% CI 0.74–1.35) and surgical type (patch or direct closure) (OR: 1.00, 95% CI 0.67–1.49) were comparable in the ALMT group and MS group. No significant differences in the success rate (OR 0.23; 95% CI 0.05–1.07) or severe complication rate (OR 1.46; 95% CI 0.41–5.22) were found between the ALMT group and the MS group. In addition, the differences in the cardiopulmonary bypass (CPB) time (WMD 6.33; 95% CI − 1.92 to 14.58 min, p = 0.13) and the operation time (WMD 5.23; 95% CI − 12.49 to 22.96 min, p = 0.56) between the ALMT group and the MS group were not statistically significant. However, the ALMT group had a significantly longer aortic cross-clamp time (2.37 min more, 95% CI 1.07–3.67 min, p = 0.0003). The intubation time was 1.82 h shorter (95% CI − 3.10 to − 0.55 h; p = 0.005), the intensive care unit (ICU) stay was 0.24 days shorter (95% CI − 0.44 to − 0.04 days; p = 0.02), and the postoperative hospital stay was 2.45 days shorter (95% CI − 3.01 to − 1.88 days; p < 0.00001) in the ALMT group than in the MS group. Furthermore, the incision length was significantly shortened by 8.97 cm in the ALMT group compared with the MS group (95% CI − 9.36 to − 8.58 cm; p < 0.00001).ConclusionsIn the surgical treatment of ASD, ALMT and MS are equally safe and effective in terms of success rates and severe complication rates. The surgical procedures are equally difficult, but ALMT is associated with a faster functional recovery and better cosmetic results. Compared to MS, ALMT is the better choice for select ASD patients.
Highlights
Atrial septal defects (ASDs) are one of the most common congenital heart defects, accounting for 10–15% of all forms of congenital cardiac malformations [1]
Right anterolateral minithoracotomy (ALMT) has been widely applied as an alternative to median sternotomy (MS) for atrial septal defects (ASD) surgical repair with similar mortality and postoperative morbidity and superior cosmetic results compared to the MS approach [3, 4]
Age (WMD 1.80, 95% CI 0.31–3.29), weight (WMD − 0.91, 95% CI − 5.57 to 3.75), sex distribution and surgical type were comparable in the ALMT group and MS group
Summary
Atrial septal defects (ASDs) are one of the most common congenital heart defects, accounting for 10–15% of all forms of congenital cardiac malformations [1]. Right anterolateral minithoracotomy (ALMT) has been widely applied as an alternative to MS for ASD surgical repair with similar mortality and postoperative morbidity and superior cosmetic results compared to the MS approach [3, 4]. One meta-analysis has already been conducted on ALMT versus MS for the treatment of congenital heart defects. Ding and his colleagues concluded that ALMT could benefit patients by reducing intubation time and postoperative hospital stay [5]. This study aimed to compare the short-term results between ALMT and MS for surgical repair of ASD. To compare the short-term safety and efficacy of right anterolateral minithoracotomy (ALMT) and median sternotomy (MS) for the surgical treatment of atrial septal defects (ASDs)
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