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Comparative Study
. 2014 Jun;57(3):E75-81.
doi: 10.1503/cjs.012813.

Clinical outcomes of minimally invasive endoscopic and conventional sternotomy approaches for atrial septal defect repair

Michael W A Chu  1 , Katie L Losenno  1 , Stephanie A Fox  1 , Corey Adams  1 , Hamad Al-Habib  1 , Ray Guo  1 , Alan H Menkis  1 , Bob Kiaii  1
Affiliations
Comparative Study

Clinical outcomes of minimally invasive endoscopic and conventional sternotomy approaches for atrial septal defect repair

Michael W A Chu et al. Can J Surg. 2014 Jun.

Abstract
in English, French

Background: Concerns remain that minimally invasive atrial septal defect (ASD) repair may compromise patient outcomes. We compared clinical outcomes of adult patients undergoing ASD repair via a minimally invasive endoscopic approach versus a "gold standard" sternotomy.

Methods: We retrospectively reviewed the clinical outcomes of consecutive patients who underwent ASD patch repair at our institution between 2002 and 2012. We compared in-hospital/30-day mortality, postoperative complications, length of stay in hospital and in the intensive care unit and blood product requirements between patients who underwent right mini-thoracotomy (MT) and those who underwent conventional sternotomy.

Results: During the study period, 73 consecutive patients underwent ASD patch repair at our institution: 51 (age 47 ± 16 yr, 66.7% women) in the MT group and 22 (age 46 ± 21 yr, 59.1% women) in the sternotomy group. In-hospital mortality was similar between the 2 groups (MT 0% v. sternotomy 4.5%, p = 0.30). There were no significant differences in any postoperative complications or blood product requirements. No patients in the MT group suffered stroke, retrograde aortic dissection or leg ischemia. Mean intensive care unit (MT 1.2 ± 1.2 d v. sternotomy 1.7 ± 2.2 d, p = 0.26) and hospital length of stays (MT 5.1 ± 2.2 d v. sternotomy 6.3 ± 3.6 d, p = 0.17) were similar between the groups; however, there was a trend toward fewer patients requiring prolonged hospital stays (> 10 d) in the MT group (3.9% v. 18.2%, p = 0.06).

Conclusion: Repair of ostium secundum and sinus venosus ASD can be performed safely via MT endoscopic approach with similar outcomes as sternotomy. Patient preference for a more cosmetically appealing incision may be considered without concern of compromised outcomes.

Contexte: Des inquiétudes persistent au sujet des résultats potentiellement négatifs chez les patients soumis à une intervention de réparation de communication interauriculaire (CIA) minimalement effractive. Nous avons comparé les résultats cliniques chez des patients adultes soumis à une réparation de CIA par approche endoscopique minimalement effractive ou par sternotomie classique — « l’étalon-or ».

Méthodes: Nous avons passé en revue de manière rétrospective les résultats cliniques chez des patients consécutifs qui ont subi un traitement d’occlusion de leur CIA dans notre établissement, entre 2002 et 2012. Nous avons comparé la mortalité en cours d’hospitalisation et à 30 jours, les complications postopératoires, la durée des séjours à l’hôpital et aux soins intensifs et le recours aux produits sanguins chez les patients selon qu’ils avaient subi une mini-thoracotomie (MT) ou une sternotomie classique.

Résultats: Durant la période de l’étude, 73 patients consécutifs ont subi un traitement d’occlusion de leur CIA dans notre établissement : 51 (âge 47 ± 16 ans, 66,7 % femmes) dans le groupe MT et 22 (âge 46 ± 21 ans, 59,1 % femmes) dans le groupe sternotomie. La mortalité perhospitalière a été similaire entre les 2 groupes (MT 0 % c. sternotomie 4,5 %, p = 0,30). On n’a noté aucune différence significative quant aux complications postopératoires et aux besoins en produits sanguins. Aucun patient du groupe MT n’a subi d’AVC, de dissection aortique rétrograde ou d’ischémie à la jambe. La durée moyenne des séjours aux soins intensifs (MT 1,2 ± 1,2 j c. sternotomie 1,7 ± 2,2 j, p = 0,26) et à l’hôpital (MT 5,1 ± 2.2 j c. sternotomie 6,3 ± 3,6 j, p = 0,17) a été similaire entre les groupes; toutefois, on a noté une tendance à un nombre moindre de patients nécessitant une hospitalisation prolongée (> 10 j) dans le groupe MT (3,9 % c. 18,2 %, p = 0,06).

Conclusion: La réparation de la CIA au niveau de l’ostium secundum et du sinus veineux peut se faire de manière sécuritaire par approche endoscopique MT, avec des résultats similaires à ceux de la sternotomie. On peut tenir compte de la préférence des patients pour une incision plus acceptable au plan esthétique sans crainte de compromettre les résultats.

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Figures

Fig. 1
Fig. 1
(A) Intraoperative photograph demonstrating the 3–4 cm right minithoracotomy (MT) and peripheral cannulation (PC) set-up for minimally invasive, endoscopic atrial septal defect closure. (B) Endoscopic view of a large secundum atrial septal defect with a sump vent going through it. (C) Endoscopic view of the autologous pericardial patch closure of the secundum atrial septal defect.
Fig. 2
Fig. 2
Postoperative photographs demonstrating (A) the minithoracotomy wound in a female patient 5 days postoperatively and (B) in a male patient 4 weeks postoperatively, and (C) the sternotomy wound in female patient 2 months postoperatively.
Fig. 3
Fig. 3
Requirement for blood transfusions during hospital admission. FFP = fresh frozen plasma; MT = minithoracotomy; pRBC = packed red blood cells; SD = standard deviation.
Fig. 4
Fig. 4
Percutaneous neck line checklist. ACT = average clotting time; NS = normal saline; RV = right ventricle; TEE = transesophageal echocardiography; U/S = ultrasonography.
See this image and copyright information in PMC

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