Lower Ministernotomy and Fast Tracking for Atrial Septal Defect

• Published in: Asian cardiovascular & thoracic annals Vol. 18; no. 2; pp. 166 - 169
• Main Authors: Karthekeyan, Baskar Ranjith, Vakamudi, Mahesh, Thangavelu, Periyasamy, Sulaiman, Sajith, Sundar, Ayya Syama, Kumar, Siva Muthu
• Format: Journal Article
• Language: English
• Published: London, England Asian Soc Cardio Surg 01.02.2010; SAGE Publications
• Subjects: Adolescent; Female; Heart Arrest, Induced - methods; Heart Septal Defects, Atrial - surgery; Humans; Intensive Care Units; Length of Stay; Male; Minimally Invasive Surgical Procedures; Sternotomy - methods; Atrial Septal Defect; Congenital; Atrial; Heart Defects; Heart Septal Defects; Surgical Procedures; Minimally Invasive
• ISSN: 0218-4923; 1816-5370
• DOI: 10.1177/0218492310362004

We report our experience with a 3–5-cm lower ministernotomy incision for closure of atrial septal defect in 53 patients. Fibrillatory arrest was used in 19 patients, and crossclamping with cardioplegia in 33. One patient had to be converted from fibrillatory arrest to crossclamping with cardioplegic arrest. The mean bypass time was 39.6 ± 13.1 min, arrest time was 9.9 ± 4.5 min, and crossclamp time was 20.7 ± 8.69 min. All patients recovered without adverse events. They were fast tracked to recovery and extubated after 63.4 ± 9.2 min. The mean intensive care unit stay was 1.07 ± 0.33 days, and hospital stay was 3.07 ± 0.38 days. The ministernotomy approach was used successfully in 51 patients; in the other 2, it had to be converted to a full sternotomy because of technical difficulties. Our experience confirms that this technique offers satisfactory cosmetic results, stable sternal reconstruction, good surgical exposure, minimal interference with respiratory mechanics, and minimal pain, allowing extubation in the operating room and a speedy recovery.