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Abstract

Objective:

To compare the safety and effectiveness of video-assisted thoracic surgery (VATS) versus conventional median sternotomy (open) in the repair of secundum atrial septal defect (ASD) or patent foramen ovale (PFO).

Design:

Among 415 consecutive patients undergoing open or VATS ASD/PFO closure between 1993 and October 2012, 153 patients were compared using 2:1 frequency matching (n = 102 open vs 51 VATS). Matching variables include age, gender, body surface area, past medical history of neurologic events, and need of patch closure. Median age was 43 years (3-71 years), and 67% were female.

Results:

There were no early deaths in either group. There were no conversions to open sternotomy. Although mean cross-clamp time (14.5 ± 7.6 vs 26.3 ± 13.2 minutes, P < .001) and bypass time (31.7 ± 13.8 vs 60.9 ± 20.9 minutes, P < .001) were longer in the VATS group, patients who underwent VATS had shorter postoperative ventilation time (7.5 ± 6.4 vs 4.4 ± 2.8 hours, P = .03) with 62.7% extubated in the operating room, along with shorter intensive care unit stay (26.7 ± 10.8 vs 19.1 ± 9.9 hours, P < .001) and hospital stay (5.2 ± 1.9 vs 3.5 ± 0.9 days, P < .001). At early follow-up (mean 1.5 years, maximum 4.2 years), there was no difference in need for reintervention. Of the 27 patients who underwent VATS ASD/PFO closure for a neurologic event, none had a recurrence.

Conclusion:

The use of VATS provides a safe, equally effective alternative to conventional sternotomy for ASD/PFO closure, using a less invasive approach.

Keywords

atrial septal defect congenital heart disease congenital heart surgery minimally invasive surgery

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References

Hoffman

Kaplan

. The incidence of congenital heart disease. J Am Coll Cardiol. 2002;39 (12):1890–1900.

Warnes

Williams

Bashore

. ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to develop guidelines on the management of adults with congenital heart disease). Circulation. 2008;118 (23):e714–e833.

Guffi

Bogousslavsky

Jeanrenaud

Devuyst

Sadeghi

. Surgical prophylaxis of recurrent stroke in patients with patent foramen ovale: a pilot study. J Thorac Cardiovasc Surg. 1996;112 (2):260–263.

Homma

Di Tullio

Sacco

Sciacca

Smith

Mohr

. Surgical closure of patent foramen ovale in cryptogenic stroke patients. Stroke. 1997;28 (12):2376–2381.

Dearani

Ugurlu

Danielson

. Surgical patent foramen ovale closure for prevention of paradoxical embolism-related cerebrovascular ischemic events. Circulation. 1999;100(19 suppl):II171–II175.

Dong

Yin

Feng

Wang

. Totally thoracoscopic closure for atrial septal defect on perfused beating hearts. Eur J Cardiothorac Surg. 2012;41 (6):1316–1319.

Bonaros

Schachner

Oehlinger

. Robotically assisted totally endoscopic atrial septal defect repair: insights from operative times, learning curves, and clinical outcome. Ann Thorac Surg. 2006;82 (2):687–693.

Aybek

Wimmer-Greinecker

. Evolution of surgical techniques for atrial septal defect repair in adults: a 10-year single-institution experience. J Thorac Cardiovasc Surg. 2007;134 (3):757–764.

Morgan

Thornton

Peacock

. Does robotic technology make minimally invasive cardiac surgery too expensive? A hospital cost analysis of robotic and conventional techniques. J Card Surg. 2005;20 (3):246–251.

10.

Yin

Dong

Feng

Wang

. Quality of life in patients undergoing totally thoracoscopic closure for atrial septal defect. Ann Thorac Surg. 2011;92 (6):2230–2234.

11.

Morgan

Peacock

Kohmoto

. Robotic techniques improve quality of life in patients undergoing atrial septal defect repair. Ann Thorac Surg. 2004;77 (4):1328–1333.

12.

Furie

Kasner

Adams

. Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011;42 (1):227–276.

13.

Suri

Burkhart

Daly

. Robotic mitral valve repair for all prolapse subsets using techniques identical to open valvuloplasty: establishing the benchmark against which percutaneous interventions should be judged. J Thorac Cardiovasc Surg. 2011;142 (5):970–979.

14.

Dong

Yin

Feng

Wang

. Totally thoracoscopic repair of atrial septal defect without robotic assistance: a single-center experience. J Thorac Cardiovasc Surg. 2011;141 (6):1380–1383.

15.

Argenziano

Kohmoto

. Totally endoscopic atrial septal defect repair with robotic assistance. Circulation. 2003;108(suppl 1):II191–II194.

16.

Vistarini

Aiello

Mattiucci

. Port-access minimally invasive surgery for atrial septal defects: a 10-year single-center experience in 166 patients. J Thorac Cardiovasc Surg. 2010;139 (1):139–145.

17.

Lechat

Mas

Lascault

. Prevalence of patent foramen ovale in patients with stroke. N Engl J Med. 1988;318 (18):1148–1152.

18.

Di Tullio

Homma

. Patent foramen ovale and stroke: what should be done? Curr Opin Hematol. 2009;16 (5):391–396.

19.

Goldstein

Bushnell

Adams

. Guidelines for the primary prevention of stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011;42 (2):517–584.

20.

Handke

Harloff

Olschewski

Hetzel

Geibel

. Patent foramen ovale and cryptogenic stroke in older patients. N Engl J Med. 2007;357 (22):2262–2268.

21.

Kent

Trikalinos

Thaler

. Patent foramen ovale and cryptogenic stroke. N Engl J Med. 2008;358(14):1519–1520; author reply 1520-1511.

22.

Almekhlafi

Wilton

Rabi

Ghali

Lorenzetti

Hill

. Recurrent cerebral ischemia in medically treated patent foramen ovale: a meta-analysis. Neurology. 2009;73 (2):89–97.

23.

Orgera

O'Malley

Taylor

. Secondary prevention of cerebral ischemia in patent foramen ovale: systematic review and meta-analysis. South Med J. 2001;94 (7):699–703.

24.

Hammerstingl

Bauriedel

Stusser

. Risk and fate of residual interatrial shunting after transcatheter closure of patent foramen ovale: a long term follow up study. Eur J Med Res. 2011;16 (1):13–19.

25.

Furlan

Reisman

Massaro

. Closure or medical therapy for cryptogenic stroke with patent foramen ovale. N Engl J Med. 2012;366 (11):991–999.

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Minimally Invasive Video-Assisted Surgical Closure of Atrial Septal Defects

Abstract

Objective:

Design:

Results:

Conclusion:

Keywords

Get full access to this article

References

Supplementary Material