Atrial septal defect minimally invasive repair


 * Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. [mailto:psingh@perfuse.org]; Assistant Editor(s)-In-Chief: Kristin Feeney, B.S. [mailto:kfeeney@perfuse.org]

Overview
Minimally invasive repair of atrial septal defect has been shown to be as successful as the conventional sternotomy, with the added advantage of being less invasive, less post-surgical complications and decreased hospital stay.

Steps in the surgery

 * Incision made through the right side of the chest.
 * Patient put on heart-lung bypass machine.
 * Tubes placed in the main artery and vein of the right leg
 * The heart stopped during operation.
 * Right atrium opened and atrial septal defect exposed
 * Defect repaired
 * Heart closed and restarted
 * Heart-lung bypass is discontinued

Type of incisions

 * Upper hemisteronomy
 * Right parasternal
 * Right submammary bikini line (for females)
 * Limited median sternotomy (for males)
 * Transxiphoid sternotomy (for children or young adults)

It is advised that an anterolateral approach only be used in adults as it may damage prepubescent girls during development of breast tissue.

Advantages

 * Less invasive
 * Smaller hospital stay
 * Smaller recovery and faster healing of wound
 * No or minimal activity restrictions post-surgery
 * Lesser infections

Trial supportive data
Studies done on 68 patients (39 conventional sternotomy, 29 minimally invasive ASD closure) to compare the safety and efficacy of minimally invasive ASD closure compared to the conventional sternotomy approach (CSA) found no statistically significant difference in morbidity and mortality. However, a significant difference in postoperative length of stay was seen. Thus, minimally invasive ASD closure (MIC) was found to be as effective as conventional sternotomy approach (CSA) with the advantage of decreased hospital stay.