Atrial Septal Defect Repair on the Beating or Non-beating Heart through Minimally Invasive Right Axillary Approach_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

DENGJian-ying ,  ZHONGQian-jin , CHENJian-ming , LIZhi-ping , HUYi-jie , SHENCheng

Department of Cardiovascular Surgery, Daping Hospital, Research Institute of Surgery, Third Military Medical University, Chongqing 400042, P. R. China;

Corresponding author：

ZHONGQian-jin, Email: zhongqianjin@qq.com

Keywords：

Beating-heart surgery; Minimally invasive surgery; Atrial septal defect

DOI：

10.7507/1007-4848.20140224

Video：

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Objective To investigate clinical outcomes of isolated atrial septal defect (ASD)repair on the beating or non-beating heart through minimally invasive right axillary approach. Methods Forty-five patients underwent isolated ASD repair through minimally invasive right axillary approach in Research Institute of Surgery, Daping Hospital of the Third Military Medical University from September 2009 to August 2011. According to different surgical techniques, all the patients were divided into a beating-heart group and a non-beating heart group. In the beating-heart group, there were 22 patients including 13 males and 9 females with their mean age of 3.2±2.1 years and body weight of 13.1±4.0 kg. There were 20 patients with ostium secundum ASD and 2 patients with ostium primum ASD. Mean ASD diameter in the beating-heart group was 12.2±5.1 mm. In the non-beating heart group, there were 23 patients including 14 males and 9 females with their mean age of 3.5±2.5 years and body weight of 12.9±3.3 kg. There were 18 patients with ostium secundum ASD, 3 patients with sinus venosus ASD, and 2 patients with ostium primum ASD. Mean ASD diameter in the non-beating heart group was 11.6±4.7 mm. Serum creatine kinase (CK), creatine kinase isoenzyme (CK-MB), aspartate aminotransferase (AST)and highly sensitive cardiac troponin I (cTnI)were examined preoperatively, after weaning from cardiopulmonary bypass (CPB), 6 hours and 24 hours postoperatively. Results There was no in-hospital death. Postoperatively, 1 patient had right atelectasis and another patient had right pneumothorax. CPB time and operation time of the beating-heart group were significantly shorter than those of the non-beating heart group (P < 0.05). There was no statistical difference in intraoperative blood transfusion, mechanical ventilation time, length of postoperative ICU stay or hospital stay, chest drainage within 24 hours postoperatively, or postoperative cardiac function between the 2 groups (P > 0.05). Preoperative levels of CK, CK-MB, AST and cTnI were all within the normal limit, and there was no statistical difference between the 2 groups (P > 0.05). After CPB, CK, CK-MB, AST and cTnI levels increased in both groups, but increased significantly greater in the non-beating heart group (P < 0.05). Postoperative levels of CK, CK-MB, AST and cTnI of the beating-heart group were significantly lower than those of the non-beating heart group (P < 0.05). Conclusion Isolated ASD repair on the beating heart via minimally invasive right axillary approach is a safe and cosmetic procedure with shorter operation time and less myocardial injury.

Citation： DENGJian-ying, ZHONGQian-jin, CHENJian-ming, LIZhi-ping, HUYi-jie, SHENCheng. Atrial Septal Defect Repair on the Beating or Non-beating Heart through Minimally Invasive Right Axillary Approach. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(6): 783-787. doi: 10.7507/1007-4848.20140224 Copy

1.	Bichell DP, Geva T, Bacha EA, et al. Minimal access approach for the repair of atrial septal defect:the initial 135 patients. Ann Thorac Surg, 2000, 70(1):115-118.
2.	Schreiber C, Bleiziffer S, Kostolny M, et al. Minimally invasive midaxillary muscle sparing thoracotomy for atrial septal defect closure in prepubescent patients. Ann Thorac Surg, 2005, 80(2):673-676.
3.	Dave HH, Comber M, Solinger T, et al. Mid-term results of right axillary incision for the repair of a wide range of congenital cardiac defects. Eur J Cardiothorac Surg, 2009, 35(5):864-869.
4.	Sebastian VA, Guleserian KJ, Leonard SR, et al. Ministernotomy for repair of congenital cardiac disease. Interact Cardiovasc Thorac Surg, 2009, 9(5):819-821.
5.	Murashita T, Hatta E, Ooka T, et al. Minimal access surgery for the repair of simple congenital heart defects:factors affecting hospital stay after surgery. Jpn J Thorac Cardiovasc Surg, 2004, 52(3):127-134.
6.	Ding C, Wang C, Dong A, et al. Anterolateral minithoracotomy versus median sternotomy for the treatment of congenital heart defects:a meta-analysis and systematic review. J Cardiothorac Surg, 2012, 7:43.
7.	Hongxin L, Wenbin G, Lijun S, et al. Intraoperative device closure of secundum atrial septal defect with a right anterior minithoracotomy in 100 patients. J Thorac Cardiovasc Surg, 2007, 134(4):946-951.
8.	Mishra S, Tomar M, Malhotra R, et al. Comparison between transcatheter closure and minimally invasive surgery for fossa ovalis atrial septal defect:a single institutional experience. Indian Heart J, 2008, 60(2):125-132.
9.	Sarris GE, Kirvassilis G, Zavaropoulus P, et al. Surgery for complications of trans-catheter closure of atrial septal defect:a multi-institutional study from the European Congenital Heart Surgeons Association. Eur J Cardiothorac Surg, 2010, 37(6):1285-1290.
10.	Menkis AH, Martin J, Cheng DC, et al. Drug, devices, technologies, and techniques for blood management in minimally invasive and conventional cardiothoracic surgery:a consensus statement from the International Society for Minimally Invasive Cardiothoracic Surgery(ISMICS)2011. Innovations(Phila), 2012, 7(4):229-241.
11.	Suchon E, Pieculewicz M, Tracz W, et al. Transcatheter closure as an alternative and equivalent method to the surgical treatment of atrial septal defect in adults:comparison of early and late results. Med Sci Monit, 2009, 15(12):612-617.
12.	Zhu P, Sun Y, Yang Q, et al. Intraoperative device closure of atrial septal defects with minimal transthoracic invasion:a singe-center experience. Tex Heart Inst J, 2013, 40(3):256-260.
13.	Yan L, Zhou ZC, Li HP, et al. Right vertical infra-axillary mini-incision for repair of simple congenital heart defects:a matched-pair analysis. Eur J Cardiothorac Surg, 2013, 43(1):136-141.
14.	李保军, 谢家声, 李保田, 等.右腋下垂直小切口心脏不停跳心内直视手术135例.中国胸心血管外科临床杂志, 2007, 14(2):152-153.
15.	杨秀滨, 王东进, 吴清玉, 等.微创心脏不停跳下房间隔缺损修补术(附46例报告).中国微创外科杂志, 2001, 1(5):284-285.
16.	Yang X, Wang D, Wu Q. Repair of atrial septal defect through a minimal right vertical infra-axillary thoracotomy in a beating heart. Ann Thorac Surg, 2001, 71(6):2053-2054.
17.	Chen L, Hao J, Ma RY, et al. The application of on-pump beating-heart surgery for partial atrioventricular septal defect:a report of 87 cases. Heart Surg Forum, 2013, 16(5):257-263.
18.	何巍, 林辉, 郑宝石, 等.浅低温体外循环心脏跳动中施术对心肌保护的实验研究.中华胸心血管外科杂志, 2001, 17(2):96-98.
19.	马瑞彦, 杨宗英, 钟前进, 等.浅低温体外循环心脏跳动下修复3岁以下房间隔缺损134例.第三军医大学学报, 2008, 30(18):1762-1763.

1. Bichell DP, Geva T, Bacha EA, et al. Minimal access approach for the repair of atrial septal defect:the initial 135 patients. Ann Thorac Surg, 2000, 70(1):115-118.
2. Schreiber C, Bleiziffer S, Kostolny M, et al. Minimally invasive midaxillary muscle sparing thoracotomy for atrial septal defect closure in prepubescent patients. Ann Thorac Surg, 2005, 80(2):673-676.
3. Dave HH, Comber M, Solinger T, et al. Mid-term results of right axillary incision for the repair of a wide range of congenital cardiac defects. Eur J Cardiothorac Surg, 2009, 35(5):864-869.
4. Sebastian VA, Guleserian KJ, Leonard SR, et al. Ministernotomy for repair of congenital cardiac disease. Interact Cardiovasc Thorac Surg, 2009, 9(5):819-821.
5. Murashita T, Hatta E, Ooka T, et al. Minimal access surgery for the repair of simple congenital heart defects:factors affecting hospital stay after surgery. Jpn J Thorac Cardiovasc Surg, 2004, 52(3):127-134.
6. Ding C, Wang C, Dong A, et al. Anterolateral minithoracotomy versus median sternotomy for the treatment of congenital heart defects:a meta-analysis and systematic review. J Cardiothorac Surg, 2012, 7:43.
7. Hongxin L, Wenbin G, Lijun S, et al. Intraoperative device closure of secundum atrial septal defect with a right anterior minithoracotomy in 100 patients. J Thorac Cardiovasc Surg, 2007, 134(4):946-951.
8. Mishra S, Tomar M, Malhotra R, et al. Comparison between transcatheter closure and minimally invasive surgery for fossa ovalis atrial septal defect:a single institutional experience. Indian Heart J, 2008, 60(2):125-132.
9. Sarris GE, Kirvassilis G, Zavaropoulus P, et al. Surgery for complications of trans-catheter closure of atrial septal defect:a multi-institutional study from the European Congenital Heart Surgeons Association. Eur J Cardiothorac Surg, 2010, 37(6):1285-1290.
10. Menkis AH, Martin J, Cheng DC, et al. Drug, devices, technologies, and techniques for blood management in minimally invasive and conventional cardiothoracic surgery:a consensus statement from the International Society for Minimally Invasive Cardiothoracic Surgery(ISMICS)2011. Innovations(Phila), 2012, 7(4):229-241.
11. Suchon E, Pieculewicz M, Tracz W, et al. Transcatheter closure as an alternative and equivalent method to the surgical treatment of atrial septal defect in adults:comparison of early and late results. Med Sci Monit, 2009, 15(12):612-617.
12. Zhu P, Sun Y, Yang Q, et al. Intraoperative device closure of atrial septal defects with minimal transthoracic invasion:a singe-center experience. Tex Heart Inst J, 2013, 40(3):256-260.
13. Yan L, Zhou ZC, Li HP, et al. Right vertical infra-axillary mini-incision for repair of simple congenital heart defects:a matched-pair analysis. Eur J Cardiothorac Surg, 2013, 43(1):136-141.
14. 李保军, 谢家声, 李保田, 等.右腋下垂直小切口心脏不停跳心内直视手术135例.中国胸心血管外科临床杂志, 2007, 14(2):152-153.
15. 杨秀滨, 王东进, 吴清玉, 等.微创心脏不停跳下房间隔缺损修补术(附46例报告).中国微创外科杂志, 2001, 1(5):284-285.
16. Yang X, Wang D, Wu Q. Repair of atrial septal defect through a minimal right vertical infra-axillary thoracotomy in a beating heart. Ann Thorac Surg, 2001, 71(6):2053-2054.
17. Chen L, Hao J, Ma RY, et al. The application of on-pump beating-heart surgery for partial atrioventricular septal defect:a report of 87 cases. Heart Surg Forum, 2013, 16(5):257-263.
18. 何巍, 林辉, 郑宝石, 等.浅低温体外循环心脏跳动中施术对心肌保护的实验研究.中华胸心血管外科杂志, 2001, 17(2):96-98.
19. 马瑞彦, 杨宗英, 钟前进, 等.浅低温体外循环心脏跳动下修复3岁以下房间隔缺损134例.第三军医大学学报, 2008, 30(18):1762-1763.

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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Atrial Septal Defect Repair on the Beating or Non-beating Heart through Minimally Invasive Right Axillary Approach

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