Closure of atrial septal defect by minimally invasive surgery: An alternative approach

Abstract

Percutaneous closure of interatrial communications (ASD) has become the standard for therapeutic management. However, some patients are ineligible for this technique due to the morphology of the ASD, thus requiring conventional surgical closure by sternotomy or lateral thoracotomy. Minimally invasive surgery (MIS) has been introduced in several adult heart surgery centers especialy for mitral surgery. The purpose is to present the preliminary experience of ASD closure by MIS. We analyzed all of the patients ( n = 5) treated from March 2019 (start date of the MIS program) to December 2019. The MIC was performed by an anterior mini thoracotomy of approximately 5 cm with femoral cannulation ( Fig. 1 ). The pre, per, and postoperative data were prospectively collected. All patients underwent postoperative vascular Doppler ultrasound of the femoral cannulation site. Average age at intervention was 27.3 years (range: 14.5–41), weight was of 60 kg (43–80) (4 women for 1 man). The median duration of CPB was 108 min (101–139), the duration of aortic cross clamping 45 min (36–61). There were no hospital deaths or major complication. One patient had a pneumothorax on D3. The median duration of extubation was 3.5 hours (3–6), the median duration of hospitalization was 8 days (6–11). Postoperative echocardiography did not show any residual ASD or pericardial effusion. All patients were sinus rhythm. No venous or arterial stenosis was observed at the cannulation sites. The average systolic pulmonary arterial pressure, was measured 34 mmHg (15–74) preoperatively, and estimated 30 mmHg (20–55) postoperatively. This clinical study shows the preliminary experience of MIS program for the closure of ASDs. This approach appears to be safe and effective, without major vascular complications. longer term follow-up is required to determine the specific role of MIS approach in the management of this patient population.