Port-access minimally invasive surgery for atrial septal defects: A 10-year single-center experience in 166 patients

Vistarini, Nicola; Aiello, Marco; Mattiucci, Gabriella; Alloni, Alessia; Cattadori, Barbara; Tinelli, Carmine; Pellegrini, Carlo; D'Armini, Andrea Maria; Viganò, Mario

doi:10.1016/j.jtcvs.2009.07.022

« Previous Next »The Journal of Thoracic and Cardiovascular Surgery
Volume 139, Issue 1 , Pages 139-145, January 2010

Port-access minimally invasive surgery for atrial septal defects: A 10-year single-center experience in 166 patients

Nicola Vistarini, MD
- Cardiac Surgery Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Address for reprints: Nicola Vistarini, MD, Divisione di Cardiochirurgia, Reparti Speciali, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy.
Marco Aiello, MD
- Cardiac Surgery Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
Gabriella Mattiucci, MD
- Cardiac Surgery Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
Alessia Alloni, MD
- Cardiac Surgery Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
Barbara Cattadori, MD
- Cardiac Surgery Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
Carmine Tinelli, MD
- Clinical Epidemiology and Biometric Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
Carlo Pellegrini, MD
- Cardiac Surgery Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
Andrea Maria D'Armini, MD
- Cardiac Surgery Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
Mario Viganò, MD
- Cardiac Surgery Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy

Received 17 January 2009; received in revised form 26 May 2009; accepted 5 July 2009. published online 26 August 2009.

Objective

We assessed the surgical results and the benefits to the patient of a minimally invasive surgical approach for atrial septal defects.

Methods

Between May 1998 and May 2008, 166 patients (median age, 44 years) had surgery for atrial septal defects in our institution. Of these patients, 118 (71%) had a patent foramen ovale (associated with atrial septal aneurysm in 48 cases), 33 (20%) had a wide ostium secundum defect, 6 (3.6%) had an ostium primum defect, 6 (3.6%) had a sinus venosus defect with abnormal pulmonary vein connection, and 1 (0.6%) had a coronary sinus defect. In 2 cases (1.2%) patients were referred to our department for surgical correction after failure of interventional occluder placement. All patients were operated on via a right minithoracotomy (mean incision, 5.5 ± 1 cm) in the fourth intercostal space and under cardiopulmonary bypass.

Results

The HeartPort access system was used in 106 patients (64%), with an endoaortic clamp (central kit in 50 cases and peripheral kit in 56). In the remaining patients (36%), we preferred the Portaclamp system (37 cases) or the Chitwood clamp (23 cases). Average crossclamp time was 38.4 ± 22.2 minutes with a mean cardiopulmonary bypass time of 64.9 ± 34.5 minutes. There was no conversion in classic sternotomy. There were no early or late hospital deaths. Surgical revision was performed in 6 patients for bleeding from the thoracic wall. The mean hospital stay was 5.8 days. At 51 months mean follow-up, 4 patients died of non–cardiac-related causes.

Conclusions

Port-access minimally invasive surgery for atrial septal defects is a safe, less-invasive, reproducible, and cosmetic operation, providing an excellent outcome and an effective correction, and could be now considered the standard approach for this type of patient.

CTSNet classification: 20, 28

Abbreviations and Acronyms: ASD, atrial septal defects, CPB, cardiopulmonary bypass, NYHA, New York Heart Association, PTFE, polytetrafluoroethylene