Repair of Atrial Septal Defects via Limited Right Anterolateral Thoracotomy

Abstract

Introduction: Right thoracotomy is a well known alternative for median sternotomy to gain access to the right atrium. The Port-Access™ technique is a surgical option to reduce the skin incision to 5 cm and have a considerable gain in cosmesis and post-operative rehabilitation.Patients and methods: From February 1997 to May 2000, 50 patients (19M/31F) had Port-Access™ atrial septal defect repair (ASD) with the Heartport® Endo-CPB and Endo-aortic clamp system. Mean age was 46 years (range10.5–74 years). Forty nine patients had a type II ASD. Most of the patients were asymptomatic (48 were NYHA class I-II). Five patients underwent combined procedures: two mitral valve repairs, one mitral valve replacement, one plasty of the superior vena cava and one mini Cox-Maze. Direct closure was obtained in 34 patients (68%). Mean aortic cross clamp time was 56 minutes (range 24–134 min) and mean perfusion time was 102 minutes (range 32–196 min). Results: There were no conversions to sternotomy. The procedure was complicated in six patients: revision for bleeding (n = 1), stenting of the iliac vein (n = 1), enlargement plasty of the femoral artery (n = 1), transient renal failure (n = 1), sick sinus syndrome requiring pacemaker implantation (n = 1) and one lymphocoele. No thromboembolic or peripheral ischaemic complications were noted. Per-and postoperative echocardiography showed no leakage in any patients. There was no hospital mortality. Mean ICU and hospital stay were 1.14 days (range 1–3 days) and 6.41 days (range 4-10 days) respectively.Conclusion: The Port-Access™ approach of ASD closure constitutes a valid alternative to sternotomy with the same standards of results and quality.