TITLE:
Atrial Septal Defect Closure by Anterior Mini Thoracotomy with Total Peripheral Cannulation: A Step towards Establishing Mini Invasive Cardiac Surgery in a Developing Nation
AUTHORS:
Prabhat Khakural, Ravi Baral, Anil Bhattarai, Bhagawan Koirala
KEYWORDS:
Atrial Septal Defect, Mini Thoracotomy, Total Peripheral Cannulation
JOURNAL NAME:
World Journal of Cardiovascular Surgery,
Vol.10 No.10,
October
26,
2020
ABSTRACT: Background: Atrial Septal Defect
(ASD) closure is a common cardiac surgical procedure performed worldwide. Due
to favourable clinical outcome, minimal invasive approach is becoming popular.
Hence this study was conducted to compare the outcome of two surgical
approaches, median sternotomy and mini thoracotomy with total peripheral
cannulation, in a developing country Nepal. Methods: A prospective study
of 62 ASD patients, randomized to undergo surgical closure either via right
anterior mini thoracotomy or median sternotomy was conducted and followed up
over three years. The clinical outcome parameters like intensive care unit
stay, hospital stay, post-operative duration of ventilation, cardiopulmonary
bypass time, aortic cross clamp time, mediastinal drainage, size of scar and
complication were compared between two groups. Results: Cardiopulmonary
bypass time and aortic cross clamp time were significantly longer in right
anterior mini thoracotomy group as compared to median sternotomy group (43.97 min ± 12.70 min vs 34.42 min ± 10.42 min and 25.13 min ± 7.82 min vs 19.48 min ± 6.93 min respectively, p-value 0.05). There was no significant difference in duration of surgery (2.75 hrs ± 0.43 hrs vs 2.56 hrs ± 0.41 hrs, p-value = 0.09), post-operative ventilation (2.90 hrs ± 1.22 hrs and 2.88 hrs ± 1.07 hrs, p-value = 0.96) between two groups. Post-operative mediastinal drainage was
significantly less in right anterior mini thoracotomy group (214.52 ml ± 91.79 ml vs 284.03 ml ± 158.91 ml, p-value = 0.04). There was no significant difference in ICU stay and hospital stay. Conclusion: Atrial septal defect can be safely closed by right anterior
mini thoracotomy with a small, cosmetically acceptable submammary scar with
less pain and bleeding.