Totally Thoracoscopic Surgical Treatment for Atrial Septal Defect: A Mid-Term Follow-up Results in 45 Consecutive Patients

BACKGROUND: Totally thoracoscopic operation provides minimally invasive alternative for patients with atrial septal defect. In this study, we report the mid-term follow-up results of 45 patients with atrial septal defect who underwent totally thoracoscopic operation and discuss the feasibility and safety of this new technique.

METHODS: From January 2010 to February 2012, 45 patients with atrial septal defect underwent totally thoracoscopic closure as an alternative to traditional median sternotomy surgery. The mean age of the patients was 33.2±12.5 years (range 6.3-61.5 years), and mean weight was 55.7±11.1kg (range 30.5-80kg). Based on echocardiography the mean size of the atrial septal defect was 16.0±10.8mm (range 13-39mm).

RESULTS: All patients underwent totally thoracoscopic repair. Twenty-five patients with a pericardial patch and 20 patients were sutured directly. Five patients underwent concomitant tricuspid valvuloplasty with Kay technique. No death, reoperation or complete atrioventricular block occurred. The mean time of cardiopulmonary bypass was 70.5±20.6min (range 31.0-153.0min), the mean time of aortic cross-clamp was 28.8±13.3min (range 0.0-80.0min) and the mean time of operation was 155.8±36.8min (range 65.0-300.0min). Postoperative mechanical ventilation averaged 5.1±2.8h (range 3.6-12.6h), and the duration of intensive care unit stay 20.0±5.6h (range 16.2-25h). The mean volume of blood drainage was 156±36ml (range 51-800ml). No death, residual shunt, lung atelectasis or moderate tricuspid regurgitation was found at three-month follow-up.

CONCLUSION: Totally thoracoscopic repair is feasible and safe for patients with ASD, even with or without tricuspid regurgitation however more clinical data is needed in the future study.