RF89 TWENTY-YEAR OF MINIMALLY INVASIVE SURGERY FOR ATRIAL SEPTAL DEFECTS: TECHNICAL EVOLUTION AND RESULTS

Abstract

Background: We evaluate the results of our 20-year experience with minimally invasive surgical approaches (MISA) for closing ostium secundum atrial septal defects (ASD II), focusing on technical evolution and efficacy. Methods: We included 538 patients who underwent surgical ASD II closure by using MISA. Results: MISA included: right-anterior mini-thoracotomy (RAMT)(n = 335, 62%), mid-line mini-sternotomy (MS) (135, 25%) and right-lateral mini-thoracotomy (RLMT) (n = 68, 13%). Central cannulation was employed in 374 patients (69%), while a remote cardiopulmonary bypass with peripheral cannulation in the remaining 164 patients (30%). Five patients (0.9%) had major postoperative complications requiring further surgical intervention. All patients were discharged in good clinical conditions, without any significant residual intra-cardiac defect. A decrease of the length of hospitalization (p < 0.001) and hospital costs (p = 0.009) was demonstrated by year of surgery. At a median follow-up of 12.1 years (IQR 0.6–14 years), all patients are in good clinical conditions with no limitation to physical activity. The overall satisfaction rate for the cosmetic result of MISA was 97% (524/538 patients)(99% in the last 5 years, 99/100 patients). Conclusions: MISA for closing ASD II proved safe and effective. A continuous evolution of MISA in our Institution was characterized by a progressive miniaturization of surgical accesses, reduced hospitalization and eventually reduced hospital costs.