Subscribe to RSS
DOI: 10.1055/s-0034-1367358
Minimally invasive surgery for congenital atrial septum defects in adults
Methods: Between 03/2004 and 04/2010, 52 patients underwent minimally invasive surgery for congenital ASD. Mean patient age was 40.79 ± 13.0 years, 34 (65.4%) were female. Indications for surgery were sinus venosus defect, shunt-volume >30% or ASD >2cm as well as persistent ASD after catheter based device-occlusion. Surgery was performed through a small right lateral mini-thoracotomy with cannulation of the peripheral vessels and video-assistance. ASD closure was conducted through the right atrium by either direct closure or pericardial patch. In the cohort, 2 (3.8%) patients suffered from a persistent foramen ovale, ASD II was present in 41 (78.8%) cases. A sinus venosus defect was found in 9 (17.3%) patients. All patients were in sinus rhythm preoperatively. Mean follow-up time was 42.3 ± 22 months. Perioperative parameters were analysed including stroke, arrhythmia, death and remaining ASD.
Results: In all patients no remaining ASD was found in the postoperative echocardiography. No major peri-operative complications, such as stroke, cardiac ischemia or death were found. Overall minor complication rate was 17.9%. Two (2.8%) patients with additional intervention of the superior vena cava required permanent pacemaker insertion. One (1.9%) patient suffered from an inguinal seroma, another one from inguinal paresthesia. In one case rethoracotomy due to hemorrhage had to be performed. Embolic occlusion of the femoral artery was reported in one case, two patients (3.8%) required drainage of a pneumothorax. All patients were in sinusrhythm postoperatively, except the two with the new permanent pacemaker.
Conclusion: In our cohort minimally invasive surgery for ASD could be performed safe and feasible without major complications. Lack of remaining ASD and longterm freedom from neurological complications are the major advantages of this procedure. Due to these favourable results minimally invasive surgery for atrial septal defects should be standard of care for patients with contraindications for or failed catheter based device-occlusion.