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 + or - 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 + or - 22.2 minutes with a mean cardiopulmonary bypass time of 64.9 + or - 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.
authors.affiliation: Cardiac Surgery Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. nvistar@tin.it
authors.forename: Nicola
authors.initials: N
authors.lastname: Vistarini
authors.forename: Marco
authors.initials: M
authors.lastname: Aiello
authors.forename: Gabriella
authors.initials: G
authors.lastname: Mattiucci
authors.forename: Alessia
authors.initials: A
authors.lastname: Alloni
authors.forename: Barbara
authors.initials: B
authors.lastname: Cattadori
authors.forename: Carmine
authors.initials: C
authors.lastname: Tinelli
authors.forename: Carlo
authors.initials: C
authors.lastname: Pellegrini
authors.forename: Andrea Maria
authors.initials: AM
authors.lastname: D'Armini
authors.forename: Mario
authors.initials: M
authors.lastname: Viganò
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General / Q000379:methods; D002315:Cardiopulmonary Bypass; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006344:Heart Septal Defects, Atrial / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D011183:Postoperative Complications; D016896:Treatment Outcome