title: Evolution of surgical techniques for atrial septal defect repair in adults: a 10-year single-institution experience.
abstract: OBJECTIVE
  We retrospectively analyzed our experience in atrial septal defect repair with varied minimally invasive surgical approaches.
  
  
  METHODS
  From 1997 to 2006, 64 patients underwent surgical repair of atrial septal defects in our center. Patients were grouped into four groups according to the approach used; group 1 (n = 16), partial lower sternotomy; group 2 (n = 20), right anterior small thoracotomy with transthoracic clamping; group 3 (n = 4), right anterior small thoracotomy with endoaortic balloon clamping; and group 4 (n = 24), totally endoscopic approach with the use of the da Vinci surgical system (Intuitive Surgical, Mountain View, Calif). Preoperative diagnosis was a large secundum type atrial septal defect in 60 patients, primum type in 3 patients, and sinus venosus type in 1 patient.
  
  
  RESULTS
  Complete atrial septal defect closure was verified by intraoperative transesophageal echocardiography in all patients. There was neither perioperative mortality nor major complication. Groups 3 and 4 had significantly longer aortic crossclamp, cardiopulmonary bypass, and skin-to-skin operative times than had groups 1 and 2 (P = .000). All groups had similar ventilation time, postoperative drainage, and intensive care unit and hospital stays. Only 2 patients in group 4 were converted to the minithoracotomy owing to endoaortic balloon failure. During the follow-up of 30 +/- 24.3 months, 1 patient in group 3 was reoperated on owing to significant residual shunting.
  
  
  CONCLUSIONS
  All types of atrial septal defects can be repaired via those four different approaches as safely as can be done by the conventional technique. General complications during surgical procedures are negligible. These approaches may be considered a standard treatment and an adjunct to transcatheter treatment options in atrial septal defect repair.
authors.affiliation: Department for Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt/Main, Germany. akkoray@hotmail.com
authors.forename: Koray
authors.initials: K
authors.lastname: Ak
authors.forename: Tayfun
authors.initials: T
authors.lastname: Aybek
authors.forename: Gerhard
authors.initials: G
authors.lastname: Wimmer-Greinecker
authors.forename: Feyzan
authors.initials: F
authors.lastname: Ozaslan
authors.forename: Farhad
authors.initials: F
authors.lastname: Bakhtiary
authors.forename: Anton
authors.initials: A
authors.lastname: Moritz
authors.forename: Selami
authors.initials: S
authors.lastname: Dogan
mesh_terms: D000328:Adult; D006348:Cardiac Surgical Procedures / Q000379:methods / Q000639:trends; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D012189:Retrospective Studies; D013997:Time Factors