Repair of atrial septal defects via limited right anterolateral thoracotomy.
BACKGROUND
Right thoracotomy is a well known alternative for median sternotomy to gain access to the right atrium. The Port-Access technique is a surgical option to reduce the skin incision to 5 cm and have a considerable gain in cosmesis and post-operative rehabilitation.


METHODS
From February 1997 to May 2000, 50 patients (19M/31F) had Port-Access atrial septal defect repair (ASD) with the Heartport Endo-CPB and Endo-aortic clamp system. Mean age was 46 years (range 10.5-74 years). Forty-nine patients had a type II ASD. Most of the patients were asymptomatic (48 were NYHA class I-II). Five patients underwent combined procedures: two mitral valve repairs, one mitral valve replacement, one plasty of the superior vena cava and one mini Cox-Maze. Direct closure was obtained in 34 patients (68%). Mean aortic cross clamp time was 56 minutes (range 24-134 min) and mean perfusion time was 102 minutes (range 32-196 min).


RESULTS
There were no conversions to sternotomy. The procedure was complicated in six patients: revision for bleeding (n = 1), stenting of the iliac vein (n = 1), enlargement plasty of the femoral artery (n = 1), transient renal failure (n = 1), sick sinus syndrome requiring pacemaker implantation (n = 1) and one lymphocoele. No thromboembolic or peripheral ischaemic complications were noted. Per- and postoperative echocardiography showed no leakage in any patients. There was no hospital mortality. Mean ICU and hospital stay were 1.14 days (range 1-3 days) and 6.41 days (range 4-10 days) respectively.


CONCLUSIONS
The Port-Access approach of ASD closure constitutes a valid alternative to sternotomy with the same standards of results and quality.
De Mulder
W
W
Department of Cardiovascular and Thoracic Surgery, OLV Ziekenhuis, Aalst, Belgium.
Vanermen
H
H
D000293:Adolescent; D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002648:Child; D015897:Comorbidity; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000453:epidemiology / Q000601:surgery*; D006349:Heart Valve Diseases / Q000453:epidemiology / Q000601:surgery; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D013908:Thoracotomy; D020535:Video-Assisted Surgery