Original ArticlesMinimally Invasive Repair of Atrial Septal Defects
Section snippets
Surgical Technique
After the induction of anesthesia and the placement of appropriate monitoring lines, the patient is prepared and draped in a supine position.
A limited skin incision (approximately 5 to 7 cm in greatest length) is made, starting from the most caudad extent of the body of the sternum (exclusive of the xiphoid process) and proceeding cephalad. The subcutaneous tissue is mobilized partially to prevent undue tension on the soft tissues. The lower part of the sternal body is exposed and the sternum
Results
Twenty-three children underwent repair of atrial septal defects using a modified ministernotomy incision at The Hospital for Sick Children from July 1995 to July 1996. There were 10 boys and 13 girls with an average age of 6 years and 2 months (range, 19 months to 15 years), an average weight of 23.3 kg (range, 11.3 to 61.7 kg), and an average body surface area of 0.78 (range, 0.48 to 1.57). The average bypass time was 35 minutes (range, 19 to 81 minutes). There were no operative or late
Comment
The median sternotomy long has been accepted as providing superior access to cardiac structures 6, 7, 8. Why, then, should we diverge from success and accept alternatives that may reduce the safety of the surgical procedure? Probably because the cosmetic disadvantages of the median sternotomy are so obvious—a large and visible scar that remains a permanent reminder of an otherwise low-risk procedure. Safety remains a cardinal feature of this modified technique.
Children and young adults who
Addendum
Since July 1996, this minimally invasive technique has been used successfully in the repair of perimembranous ventricular septal defects, ostium primum atrial septal defects, and atrioventricular valve abnormalities.
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Minimally invasive approaches to atrial septal defect closure
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2018, Diagnosis and Management of Adult Congenital Heart Disease: Third EditionAtrial Septal Defect (Interatrial Communication)
2017, Diagnosis and Management of Adult Congenital Heart DiseaseLower ministernotomy. Review of surgical and cosmetic results in our first 100 cases
2015, Cirugia CardiovascularTotally endoscopic atrial septal repair with or without robotic assistance: A systematic review and meta-analysis of case series
2013, Heart Lung and CirculationCitation Excerpt :Although many ASDs can be closed with septal occluder devices through cardiac catheterisation, surgical repair still remains a major method for ASD with unsuitable anatomy for catheter treatment [3,4]. Minimally invasive cardiac procedures have become a part of routine surgical ASD repair or closure with the development of surgical instruments and peripheral cardiopulmonary bypass (CPB) [5–11]. In the last decade, totally endoscopic ASD repair has become possible using the robotic systems, with a high success rate and a low complication rate in case reports or case series [12–17].