Minimally Invasive Atrial Septal Defect Closure: A Single Center Experience

Yıl 2022, Cilt: 32 Sayı: 6, 756 - 760, 31.12.2022

Mehmet Çelik , Asım Çağrı Günaydın Mehmet Özülkü

https://doi.org/10.54005/geneltip.1178921

Öz

Minimally Invasive Atrial Septal Defect Closure: A Single Center Experience
Summary and Abstract
Objective:In this study, we wanted to share the results of minimally invasive atrial septal defect closure in our clinic.
Materials and methods: Thirty-six patients who underwent minimally invasive atrial septal defect closure in our clinic between September 2016 and September 2022 were included in the study. Patients who underwent atrial septal defect closure accompanying another cardiac anomaly were excluded from the study. Redo cases in which the sternum was opened before were excluded from the study. Demographic data, physical examination findings, transthoracic echocardiographic and angiographic examination data of the patients were obtained retrospectively from the database of our hospital. Patients with genetic anomalies were noted. This study was approved by the Medical and Health Sciences Research Board of our institution (Project no:KA22/400).
Results: Thirty-six patients (male:11(31%), female:25(69%)) were included in the study. The median age of the patients was 57 months (IQR: 43-83 months) and the median body weight was 16 kg (IQR: 12.7-21.7 kg). Chromosomal anomaly was detected in two (5.5%) patients. A secundum atrial septal defect was detected in 31 (86%) patients, high venosum atrial septal defect in four (11%), and low venosum atrial septal defect in one (3%). Partial sternotomy was performed in 20 patients (56%), and total sternotomy was performed in 16 (44%). The median cardiopulmonary bypass time of the patients was 46.5 minutes (IQR: 36.8-57.2 minutes), and the median X-clamp times were 21.5 minutes (IQR: 15-28.7 minutes). Nine (25%) patients' defects were closed with a patch, and 27 (75%) patients' defects were closed primarily. No mortality was observed in any patient. The median hospital stay was 5 days (IQR: 4-5 days).
Discussion: In our study, no mortality or morbidity was found in cases of atrial septal defect closure performed with minimally invasive method. Minimally invasive atrial septal defect closure can be performed with similar safety and better cosmetic results compared to the standard method.

Anahtar Kelimeler

Atrial Septal Defect, Minimally Invasive Cardiac Surgery, Congenital Heart Disease

Proje Numarası

KA22/400

Minimal İnvaziv Atriyal Septal Defekt Kapatılması: Tek Merkez Deneyimi

Öz

Minimal İnvaziv Atriyal Septal Defekt Kapatılması: Tek Merkez Deneyimi
Özet
Amaç: Bu çalışmada, kliniğimizde minimal invaziv atriyal septal defekt kapatılması yapılan hastaların sonuçlarını paylaşmak istedik.

Gereç ve Yöntemler: Kliniğimizde Eylül 2016 - Eylül 2022 tarihleri arasında minimal invaziv yöntemle atriyal septal defekt kapatılması yapılan 36 hasta çalışmaya alındı. Başka bir kardiyak anomaliye eşlik eden atriyal septal defekt kapatılması yapılan hastalar çalışma dışı bırakıldı. Sternumun daha önce açıldığı redo vakalar çalışma dışı bırakıldı. Hastaların demografik verileri, fizik muayene bulguları, transtorasik ekokardiyografik ve anjiyografik incelemelerine ait veriler hastanemiz veri tabanından retrospektif olarak elde edildi. Genetik anomalisi olan hastalar not edildi. Bu çalışma bağlı bulunduğumuz kurumun Tıp ve Sağlık Bilimleri Araştırma Kurulu tarafından onaylanmıştır(proje no: KA22/400).
Bulgular: Çalışmaya 36 hasta (erkek:11(%31), kız:25(%69)) dâhil edildi. Hastaların yaşları medyan 57 ay (IQR: 43-83 ay) ve vücut ağırlıkları medyan 16 kg (IQR: 12,7-21,7 kg) olarak saptandı. İki (%5,5) hastada kromozom anomalisi saptandı. Otuz bir (%86) hastada sekundum atriyal septal defekt, dört (%11) hastada high venosum atrial septal defekt ve bir (%3) hastada low venosum atriyal septal defekt saptandı. Yirmi hastada (%56) parsiyel sternotomi, 16 (%44) hastada total sternotomi yapıldı. Hastaların kardiyopulmoner by-pass süreleri medyan 46,5 dakika (IQR: 36,8-57,2 dakika) ve X klemp süreleri medyan 21,5 dakika (IQR: 15-28,7 dakika) olarak saptandı. Dokuz (%25) hastanın defekti yama ile, 27 (%75) hastanın defekti ise pirimer kapatıldı. Hiçbir hastada mortalite izlenmedi. Hastanede kalış süresi medyan 5 gün (IQR: 4-5 gün) olarak saptandı.
Sonuç: Çalışmamızda minimal invaziv yöntemle yapılan atriyal septal defekt kapatılması olgularında mortalite ve morbiditeye rastlanmamıştır. Minimal invaziv atriyal septal defekt kapatılması standart yönteme oranla benzer güvenlikle ve daha iyi kozmetik sonuçlarla yapılabilir.

Anahtar Kelimeler

Atriyal Septal Defekt, Minimal İnvaziv Kalp Cerrahisi, Konjenital Kalp Hastalığı

Proje Numarası

KA22/400

Kaynakça

• 1. Konstantinov, I.E. Kotani Y, Buratto E et al.(2022). Minimally invasive approaches to atrial septal defect closure. JTCVS Techniques.
• 2. Sharma V, DeShazo RA, Skidmore CR, et al. Surgical explantation of atrial septal closure devices for refractory nickel allergy symptoms. J Thorac Cardiovasc Surg. 2020;160:502-9.
• 3. Naimo PS, Konstantinov IE. Commentary: a nickel for your thoughts: an overlooked allergen in implantable devices? J Thorac Cardiovasc Surg. 2020;160: 512-4.
• 4. Wertman B, Azarbal B, Riedl M, et al. Adverse events associated with nickel allergy in patients undergoing percutaneous atrial septal defect or patent foramen ovale closure. J Am Coll Cardiol. 2006;47:1226-7.
• 5. Verma DR, Khan MF, Tandar A, et al. Nickel elution properties of contemporary interatrial shunt closure devices. J Invasive Cardiol. 2017;27:99-104.
• 6. 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;80:673-6.
• 7. Özkan M, Beyazpınar D.S, Çelik M. Et al. Pleuropericardial Window Prevents Pericardial Effusion Following Surgical Atrial Septal Defect Closure. Anatolian Journal of Cardiology/Anadolu Kardiyoloji Dergisi, 2022, 26.9.
• 8. Luo H,Wang J, Qiao C, Zhang X, et al. Evaluation of different minimally invasive techniques in the surgical treatment of atrial septal defect. J Thorac Cardiovasc Surg. 2014;148:188-93.
• 9. Formigari R, Di Donato RM, Mazzera E, et al. Minimally invasive or interventional repair of atrial septal defects in children: experience in 171 cases and comparison with conventional strategies. J Am Coll Cardiol. 2001;37:1707-12.
• 10. Dave HH, Comber M, Solinger T. et al Midterm results of right axillary incision for the repair of a wide range of congenital cardiac defects. Eur J Cardiothorac Surg. 2009;35:864-70.
• 11. Liu Y, Zhang H, Sun H, et al. Repair of cardiac defects through a shorter right lateral thoracotomy in children. Ann Thorac Surg. 2000;70:738-41.
• 12. Giamberti A, Mazzera E, Di Chiara L, et al. Right submammary minithoractomy for repair of congenital heart defects. Eur J Cardiothorac Surg. 2000;18:678-82.
• 13. Lee T, Weiss AJ, Williams EE, Kiblawi F, et al. The right axillary incision: a potential new standard of care for selected congenital heart surgery. Semin Thorac Cardiovasc Surg. 2018;30:310-6.
• 14. Sebastian VA, Guleserian KJ, Leonard SR, et al. Ministernotomy for repair of congenital cardiac disease. Interact Cardiovasc Thorac Surg. 2009;9: 819-21.
• 15. 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;70:115-8.
• 16. Black MD, Freedom RM. Minimally invasive repair of atrial septal defects. Ann Thorac Surg. 1998;65:765-7.
• 17. Yan L, Zhou Z-C, Li H-P, et al. Right vertical infraaxillary mini-incision for repair of simple congenital heart defects: a matchedpair analysis. Eur J Cardiothorac Surg. 2013;43:136-41.
• 18. Yoshimura N, Yamaguchi M, Oshima Y, et al. Repair of atrial septal defect through a right posterolateral thoracotomy: a cosmetic approach for female patients. Ann Thorac Surg. 2001;72:2103-5.
• 19. Mishaly D, Ghosh P, Preisman S. Minimally invasive congenital cardiac surgery through right anterior minithoracotomy approach. Ann Thorac Surg. 2008;85: 831-5.
• 20. Barbero-Marcial M, Tanamati C, Jatene MB, et al. Transxiphoid approach without median sternotomy for the repair of atrial septal defects. Ann Thorac Surg. 1998;65:771-4.
• 21. Grinda J-M, Folliguet TA, Dervanian P, et al. Right anterolateral thoracotomy for repair of atrial septal defect. Ann Thorac Surg. 1996;62:175-8.
• 22. Schreiber C, Bleiziffer S, Lange R. Midaxillary lateral thoracotomy for closure of atrial septal defects in pre-pubescent female children: reappraisal of an “old technique.” Cardiol Young. 2003;13:565-7.
• 23. van deWal H. Cardiac surgery by transxiphoid approach without sternotomy. Eur J Cardiothorac Surg. 1998;13:551-4.
• 24. Naimo PS, Konstantinov IE. Small incisions for small children: is right lateral thoracotomy a right approach in open heart surgery in infants? Heart Lung Circ. 2016;25:104-6.
• 25. Vida VL, Tessari C, Putzu A, et al. The peripheral cannulation technique in minimally invasive congenital cardiac surgery. Int J Artif Organs. 2016;39:300-3.
• 26. Bleiziffer S, Schreiber C, Burgkart R, et al. The influence of right anterolateral thoracotomy in prepubescent female patients on late breast development and on the incidence of scoliosis. J Thorac Cardiovasc Surg. 2004;127:1474-80.
• 27. Isik O, Ayik MF, Akyuz M, et al. Right anterolateral thoracotomy in the repair of atrial septal defect: effect on breast development: thoracotomy effect on breast. J Card Surg. 2015;30:714-8.
• 28. Hagl C, Stock U, Haverich A, et al. Evaluation of different minimally invasive techniques in pediatric cardiac surgery. Chest. 2001;119:622-7.
• 29. Wang F, Li M, Xu X, et al. Totally thoracoscopic surgical closure of atrial septal defect in small children. Ann Thorac Surg. 2011;92:200-3.
• 30. Yu SQ, Cai ZJ, Cheng YG, et al. Video-assisted thoracoscopic surgery for congenital heart disease. Asian Cardiovasc Thorac Ann. 2002;10:228-30.
• 31. Kadner, A, Dave, H. Dodge-Khatami A., Bettexet al. (2004, January). Inferior partial sternotomy for surgical closure of isolated ventricular septal defects in children. In Heart Surg Forum (Vol. 7, No. 5, pp. E467-70).