Comparison of Short-Term Results between Minimally Invasive Cardiac Surgery and Conventional Median Sternotomy for Atrial Septal Defect Closure

Abstract

Background: Median sternotomy (MS) is the standard approach for atrial septal defect (ASD) closure. Recently, minimally invasive cardiac surgery (MICS) for ASD closure via right mini-thoracotomy has been proposed as a promising alternative approach. Objective: To compare short-term results of standard median sternotomy with minimally invasive cardiac surgery for ASD closure in Ramathibodi Hospital. Materials and Methods: The authors retrospectively analyzed 59 patients who underwent surgical ASD closure between January 2014 and July 2020. There were 32 patients in MICS group and 27 patients in MS group. Patient demographic datas, intraoperative parameters and postoperative results were collected and compared between the two groups. Results: There were no statistically significant difference in age, gender, body mass index, mean pulmonary artery pressure and left ventricular ejection fraction between the two groups. Intraoperative parameters were not difference in ASD size, concomitant procedures and aortic cross-clamp time. Complete atrial septal defect closure were achieved in all patients of both groups without residual defect. Median cardiopulmonary bypass time was significantly longer in MICS group (91 (77, 140) min vs. 76 (51, 98) min p=0.006). The success rate of MICS approach was 96.9% (31 of 32 patients) and conversion rate was 3.1% (1 of 32 patients). Postoperative median drainage volume and incidence of patients required PRC transfusion were significantly lower in MICS group (270 (145, 480) ml vs. 460 (300, 660) ml p=0.002) and (43% vs. 85% p=0.001) respectively. Postoperative ventilation time, pain score, analgesic drug usage, neurological complications, renal complications, wound infection, ICU stay and hospital stay were similar. Conclusion: MICS for ASD closure is a reliable alternative approach that has lower post-operative drainage volume and incidence of PRC transfusion when compared to standard median sternotomy. However, MICS has longer cardiopulmonary bypass time but no difference in post-operative complications and hospital stay.