Port-access minimally invasive surgery for atrial septal defects: A 10-year single-center experience in 166 patients

Nicola Vistarini, Marco Aiello, Gabriella Mattiucci, Alessia Alloni, Barbara Cattadori, Carmine Tinelli, Carlo Pellegrini, Andrea Maria D'Armini, Mario Viganò

Research output: Contribution to journalArticle

Abstract

Objective: We assessed the surgical results and the benefits to the patient of a minimally invasive surgical approach for atrial septal defects. Methods: Between May 1998 and May 2008, 166 patients (median age, 44 years) had surgery for atrial septal defects in our institution. Of these patients, 118 (71%) had a patent foramen ovale (associated with atrial septal aneurysm in 48 cases), 33 (20%) had a wide ostium secundum defect, 6 (3.6%) had an ostium primum defect, 6 (3.6%) had a sinus venosus defect with abnormal pulmonary vein connection, and 1 (0.6%) had a coronary sinus defect. In 2 cases (1.2%) patients were referred to our department for surgical correction after failure of interventional occluder placement. All patients were operated on via a right minithoracotomy (mean incision, 5.5 ± 1 cm) in the fourth intercostal space and under cardiopulmonary bypass. Results: The HeartPort access system was used in 106 patients (64%), with an endoaortic clamp (central kit in 50 cases and peripheral kit in 56). In the remaining patients (36%), we preferred the Portaclamp system (37 cases) or the Chitwood clamp (23 cases). Average crossclamp time was 38.4 ± 22.2 minutes with a mean cardiopulmonary bypass time of 64.9 ± 34.5 minutes. There was no conversion in classic sternotomy. There were no early or late hospital deaths. Surgical revision was performed in 6 patients for bleeding from the thoracic wall. The mean hospital stay was 5.8 days. At 51 months mean follow-up, 4 patients died of non-cardiac-related causes. Conclusions: Port-access minimally invasive surgery for atrial septal defects is a safe, less-invasive, reproducible, and cosmetic operation, providing an excellent outcome and an effective correction, and could be now considered the standard approach for this type of patient.

Original languageEnglish
Pages (from-to)139-145
Number of pages7
JournalJournal of Thoracic and Cardiovascular Surgery
Volume139
Issue number1
DOIs
Publication statusPublished - Jan 2010

Fingerprint

Minimally Invasive Surgical Procedures
Atrial Heart Septal Defects
antineoplaston A10
Cardiopulmonary Bypass
Patent Foramen Ovale
Sternotomy
Coronary Sinus
Pulmonary Veins
Thoracic Wall
Reoperation
Cosmetics
Aneurysm
Length of Stay
Hemorrhage

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

@article{9cf64dc101474e0cb5ef9d12b086b194,
title = "Port-access minimally invasive surgery for atrial septal defects: A 10-year single-center experience in 166 patients",
abstract = "Objective: We assessed the surgical results and the benefits to the patient of a minimally invasive surgical approach for atrial septal defects. Methods: Between May 1998 and May 2008, 166 patients (median age, 44 years) had surgery for atrial septal defects in our institution. Of these patients, 118 (71{\%}) had a patent foramen ovale (associated with atrial septal aneurysm in 48 cases), 33 (20{\%}) had a wide ostium secundum defect, 6 (3.6{\%}) had an ostium primum defect, 6 (3.6{\%}) had a sinus venosus defect with abnormal pulmonary vein connection, and 1 (0.6{\%}) had a coronary sinus defect. In 2 cases (1.2{\%}) patients were referred to our department for surgical correction after failure of interventional occluder placement. All patients were operated on via a right minithoracotomy (mean incision, 5.5 ± 1 cm) in the fourth intercostal space and under cardiopulmonary bypass. Results: The HeartPort access system was used in 106 patients (64{\%}), with an endoaortic clamp (central kit in 50 cases and peripheral kit in 56). In the remaining patients (36{\%}), we preferred the Portaclamp system (37 cases) or the Chitwood clamp (23 cases). Average crossclamp time was 38.4 ± 22.2 minutes with a mean cardiopulmonary bypass time of 64.9 ± 34.5 minutes. There was no conversion in classic sternotomy. There were no early or late hospital deaths. Surgical revision was performed in 6 patients for bleeding from the thoracic wall. The mean hospital stay was 5.8 days. At 51 months mean follow-up, 4 patients died of non-cardiac-related causes. Conclusions: Port-access minimally invasive surgery for atrial septal defects is a safe, less-invasive, reproducible, and cosmetic operation, providing an excellent outcome and an effective correction, and could be now considered the standard approach for this type of patient.",
author = "Nicola Vistarini and Marco Aiello and Gabriella Mattiucci and Alessia Alloni and Barbara Cattadori and Carmine Tinelli and Carlo Pellegrini and D'Armini, {Andrea Maria} and Mario Vigan{\`o}",
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T1 - Port-access minimally invasive surgery for atrial septal defects

T2 - A 10-year single-center experience in 166 patients

AU - Vistarini, Nicola

AU - Aiello, Marco

AU - Mattiucci, Gabriella

AU - Alloni, Alessia

AU - Cattadori, Barbara

AU - Tinelli, Carmine

AU - Pellegrini, Carlo

AU - D'Armini, Andrea Maria

AU - Viganò, Mario

PY - 2010/1

Y1 - 2010/1

N2 - Objective: We assessed the surgical results and the benefits to the patient of a minimally invasive surgical approach for atrial septal defects. Methods: Between May 1998 and May 2008, 166 patients (median age, 44 years) had surgery for atrial septal defects in our institution. Of these patients, 118 (71%) had a patent foramen ovale (associated with atrial septal aneurysm in 48 cases), 33 (20%) had a wide ostium secundum defect, 6 (3.6%) had an ostium primum defect, 6 (3.6%) had a sinus venosus defect with abnormal pulmonary vein connection, and 1 (0.6%) had a coronary sinus defect. In 2 cases (1.2%) patients were referred to our department for surgical correction after failure of interventional occluder placement. All patients were operated on via a right minithoracotomy (mean incision, 5.5 ± 1 cm) in the fourth intercostal space and under cardiopulmonary bypass. Results: The HeartPort access system was used in 106 patients (64%), with an endoaortic clamp (central kit in 50 cases and peripheral kit in 56). In the remaining patients (36%), we preferred the Portaclamp system (37 cases) or the Chitwood clamp (23 cases). Average crossclamp time was 38.4 ± 22.2 minutes with a mean cardiopulmonary bypass time of 64.9 ± 34.5 minutes. There was no conversion in classic sternotomy. There were no early or late hospital deaths. Surgical revision was performed in 6 patients for bleeding from the thoracic wall. The mean hospital stay was 5.8 days. At 51 months mean follow-up, 4 patients died of non-cardiac-related causes. Conclusions: Port-access minimally invasive surgery for atrial septal defects is a safe, less-invasive, reproducible, and cosmetic operation, providing an excellent outcome and an effective correction, and could be now considered the standard approach for this type of patient.

AB - Objective: We assessed the surgical results and the benefits to the patient of a minimally invasive surgical approach for atrial septal defects. Methods: Between May 1998 and May 2008, 166 patients (median age, 44 years) had surgery for atrial septal defects in our institution. Of these patients, 118 (71%) had a patent foramen ovale (associated with atrial septal aneurysm in 48 cases), 33 (20%) had a wide ostium secundum defect, 6 (3.6%) had an ostium primum defect, 6 (3.6%) had a sinus venosus defect with abnormal pulmonary vein connection, and 1 (0.6%) had a coronary sinus defect. In 2 cases (1.2%) patients were referred to our department for surgical correction after failure of interventional occluder placement. All patients were operated on via a right minithoracotomy (mean incision, 5.5 ± 1 cm) in the fourth intercostal space and under cardiopulmonary bypass. Results: The HeartPort access system was used in 106 patients (64%), with an endoaortic clamp (central kit in 50 cases and peripheral kit in 56). In the remaining patients (36%), we preferred the Portaclamp system (37 cases) or the Chitwood clamp (23 cases). Average crossclamp time was 38.4 ± 22.2 minutes with a mean cardiopulmonary bypass time of 64.9 ± 34.5 minutes. There was no conversion in classic sternotomy. There were no early or late hospital deaths. Surgical revision was performed in 6 patients for bleeding from the thoracic wall. The mean hospital stay was 5.8 days. At 51 months mean follow-up, 4 patients died of non-cardiac-related causes. Conclusions: Port-access minimally invasive surgery for atrial septal defects is a safe, less-invasive, reproducible, and cosmetic operation, providing an excellent outcome and an effective correction, and could be now considered the standard approach for this type of patient.

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