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% female, with mean age of 27.4±16.1 years), were operated through an inverted L mini-sternotomy. 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 size of 15.7±0.8 e 6.8±0.6cm, 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 not difference in the operative and postoperative periods between the techniques that were performed except the incision size, with a better cosmetic result seen with the inverted L mini-sternotomy.
Highlights
The complete longitudinal sternotomy is the most commonly utilized incision for surgeons to access the heart and great vessels, because it allows ample approach to these structures
Lateral thoracotomy [1] and parasternal minithoracotomy [2] represent alternative forms of access to the heart, which were developed with the aim of decreasing the trauma of the sternotomy
In the patients of Group A, the approach was by complete longitudinal sternotomy and in Group B patients the form of access was the inverted ‘L’ mini-sternotomy
Summary
The complete longitudinal sternotomy is the most commonly utilized incision for surgeons to access the heart and great vessels, because it allows ample approach to these structures. This approach presents disadvantages due to the aesthetic aspect, the possible occurrence of sternal instability in the postoperative period and the possibility of infection, mainly in old and diabetic patients. Lateral thoracotomy [1] and parasternal minithoracotomy [2] represent alternative forms of access to the heart, which were developed with the aim of decreasing the trauma of the sternotomy. Other variations have been suggested: from smaller incisions in the skin [3] with complete sternotomy, to video-assisted thoracic surgery [4].
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