Atrial septal defects closure through midaxillary lateral minithoracotomy with induced ventricular fibrillation

Abstract

Background. Atrial septal defects closure nowadays is a relatively low-risk procedure; therefore, a cosmetic outcome of intervention is a very important factor. A midline scar after full sternotomy is cosmetically unsatisfactory for some patients. Different types of lateral thoracotomies (anterolateral, posterolateral) might result in asymmetry of the chest and mammary glands in women. An alternative surgical approach, such as midaxillary lateral minithoracotomy can be used for better cosmetic results without increasing operative risks.
Methods. We performed a retrospective analysis of 100 patients operated at Academician Ye. Meshalkin Novosibirsk Research Institute of Circulation Pathology over a period from July 2012 to December 2013 by using midaxillary lateral minithoracotomy. There were 96 cases of isolated secundum ASD unsuitable for transcatheter closure and 4 cases of ASD with partial anomalous pulmonary venous connection (PAPVC). Direct aortic and caval cannulation was performed in all cases; induced ventricular fibrillation was used during intracardiac repair instead of aortic cross-clamping and cardioplegia.
Results. No mortality was observed. Neither was there a need in access conversion. Mean age amounted to 45.9±41.3 months (from 11 months to 17 years). Average weight was 16.0±10.3 kg (from 6.7 to 76 kg). Mean CPB ran to 29.5±9.9 min (from 12 to 57 min), mean duration of ventricular fibrillation was 12.9±5.6 min (from 5 to 27 min).
Conclusion. Midaxillary lateral minithoracotomy is a safe and convenient approach for isolated ASD closure or in cases with PAPVC, providing excellent cosmetic results and can be used in patients with almost any weight and of any age.