title: Different approaches for minimally invasive closure of atrial septal defects.
abstract: BACKGROUND
  To improve the acceptance of cosmetic results after closure of atrial septal defects, anterior or lateral thoracotomies are preferred rather than median sternotomies. Along with the availability of minimally invasive techniques, a further reduction in incision length appeared feasible while preserving thoracic stability.
  
  
  METHODS
  Various minimally invasive approaches differing in the type of incision and mode of cannulation have been applied under conditions of normothermic ventricular fibrillation. In technique 1 (n = 5), a right parasternal mini-incision was combined with a central aortic and bicaval cannulation. Technique 2 (n = 2) was composed of an anterior submammary mini-incision with femoral arterial and central bicaval cannulation. To optimize the surgical access, the transincisional cannulation of the superior vena cava was replaced by a percutaneous cervical cannulation (technique 3, n = 17).
  
  
  RESULTS
  Effective atrial septal defect closure assessed by intraoperative echocardiography was achieved in all patients. Central neurologic complications were completely absent. Besides temporary atrial fibrillation in one case, no other cardiac complications occurred. There were no cases with complicated wound healing.
  
  
  CONCLUSIONS
  Along with modified cannulation techniques and intraoperative echocardiography, minimally invasive techniques can be safely applied for atrial septal defect closure. Submammary incisions were highly accepted and allowed for adequate surgical exposure.
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Surgical Center, Hannover Medical School, Germany.
authors.forename: J T
authors.initials: JT
authors.lastname: Cremer
authors.forename: A
authors.initials: A
authors.lastname: Böning
authors.forename: M B
authors.initials: MB
authors.lastname: Anssar
authors.forename: P Y
authors.initials: PY
authors.lastname: Kim
authors.forename: K
authors.initials: K
authors.lastname: Pethig
authors.forename: W
authors.initials: W
authors.lastname: Harringer
authors.forename: A
authors.initials: A
authors.lastname: Haverich
mesh_terms: D000293:Adolescent; D000328:Adult; D006348:Cardiac Surgical Procedures / Q000379:methods; D002404:Catheterization; D002405:Catheterization, Central Venous; D005260:Female; D005263:Femoral Artery; D006344:Heart Septal Defects, Atrial / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D013249:Sternum / Q000601:surgery; D013908:Thoracotomy / Q000379:methods