Parasternal Minimally Incision in the Treatment of Atrial Septal Defect_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding?author：

Keywords：

Atrial septal defect; Parasternal minimally incision; Minimally invasive treatment procedure

DOI：

10.7507/1007-4848.20160005

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Objective To evaluate the advantages and disadvantages of parasternal minimally incision surgery over median sternotomy to treat atrial septal defect (ASD) patients. Methods We retrospectively analyzed the clinical data of 55 ASD patients received ASD closure under cardiopulmonary bypass (CPB) in Department of Cardiovascular Surgery, West China Hospital from November 2010 through March 2014. There were 16 males and 39 females with an average age of 25.8 (range, 9-56 years). All the patients were divided into two groups depending on different surgical approach:a median sternotomy group (a MS group, 15 patients)and a parasternal minimally incision group (a PMI group, 40 patients). There was no statistical difference in age, gender, weight, cardiac function classification (NYHA), and atrial septal defect diameter between the two groups (P>0.05). We analyzed the clinical data of the patients and followed up for 6 months. Results After operation, no death occurred in the two groups. One patient in the MS group prolonged hospitalization due to poor postoperative heart function. One patient in the PMI group prolonged hospitalization because of pulmonary infection. Patients in the PMI group had longer operation time (P=0.007) and cardiopulmonary bypass (CPB) time (P < 0.001), higher cost in hospital (P=0.040), less intraoperative blood loss, less postoperative drainage volume on the first day (both P < 0.001). There was no statistical difference in aortic clamp time (P=0.500) mean hospital stay (P=0.290) after operation between the two groups. To eliminate the interference of the learning curve, there was no statistical difference in operation time (P=0.275) and hospitalization cost (P=0.188) between the two groups. While there was a statistical difference in CPB time between the two groups (P=0.007). There was no remnant shunts or wound complications in the two groups at the end of following up for 6 months. More patients in the PMI group could engage in non-strenuous activities with a statistical difference (P < 0.001). Conclusion Parasternal minimally incision in the treatment of atrial septal defect is safe, effective, minimally invasive, with easy operation and shorter learning curve. It can be used as an important part of minimally invasive treatment procedure of congenital heart disease.

Citation： FANGZhi, LINKe. Parasternal Minimally Incision in the Treatment of Atrial Septal Defect. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(1): 17-20. doi: 10.7507/1007-4848.20160005 Copy

1.	劉迎龍.常見先天性心臟病外科治療的進展.心肺血管病雜志, 2012, 31(4): 353-354.
2.	Kazmouz S, Kenny D, Cao QL, et al. Transcatheter closure of secun-dum atrial septal defects. J Invasive Cardiol, 2013, 25(5): 257-264.
3.	Liang T, Xiang JZ, Xiao JM, et al. New minimally invasive technique to occlude secundum atrial septal defect in 53 patients. Ann Thorac Surg, 2006, 81(4): 1417-1419.
4.	Hongxin L, Wenbin G, Lijun S, et al. Intraoperative device closure of secundum atrial septal defect with a right anterior minithoraco-tomy in 100 patients. J Thorac Cardiovasc Surg, 2007, 134(4): 946-951.
5.	李巔遠, 閆軍, 李守軍, 等.三種不同微創技術與經典外科技術治療房間隔缺損的臨床對比研究.中國胸心血管外科臨床雜志, 2009, 16(1): 31-35.
6.	任建立, 姚建民, 程偉偉, 等.不同微創技術在繼發孔房間隔缺損治療中的應用.中國循證心血管醫學雜志, 2011, 3(2): 97-100.
7.	唐紅, 張爾永, 解俊敏, 等.食管超聲心動圖監測下經胸微創房間隔缺損封堵術.中國胸心血管外科臨床雜志, 2006, 13(5): 349-351.
8.	吳勤, 楊一峰, 徐新華, 等.超聲心動圖在外科微創封堵治療繼發孔房間隔缺損中的應用研究.中南大學學報(醫學版), 2013, 38(6): 602-609.
9.	李建榮, 劉迎龍, 于存濤, 等.右外側小切口剖胸先天性心臟病矯治術近遠期療效觀察.心肺血管病雜志, 2012, 31(4): 377-380.
10.	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(5): 43.
11.	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.
12.	程云閣, 王躍軍, 張泉, 等.完全胸腔鏡下體外循環心臟手術674例臨床分析.中華外科雜志, 2007, 45(22): 1521-1523.
13.	張曉慎, 郭惠明, 劉菁, 等.完全胸腔鏡下與胸骨切口直視房間隔缺損修補術的臨床比較.中華胸心血管外科雜志, 2014, 30(3): 152-155.
14.	劉學剛, 施超, 唐震, 等. 389例先天性心臟病右外側小切口剖胸心內直視手術.心肺血管病雜志, 2012, 31(4): 361-363.
15.	劉迎龍.右外側小切口剖胸在先天性心臟病手術中的應用.中國微創外科雜志, 2004, 4(5): 358-359.
16.	蘇俊武, 凌雁, 李曉鋒, 等.右外側小切口剖胸矯治小兒先天性心臟病1972例.心肺血管病雜志, 2012, 31(4): 358-360.
17.	Yao DK, Chen H, Ma LL, et al. Totally endoscopic atrial septal repair with or without robotic assistance: a systematic review and meta-analysis of case series. Heart Lung Circ, 2013, 22(6): 433-440.
18.	唱寬, 谷天祥, 李峰.繼發孔型房間隔缺損三種術式比較分析.寧夏醫學雜志, 2014, 36(4): 323-325.
19.	何發明, 王平凡, 梁志強, 等.右腋下小切口心臟直視手術3012例的臨床應用.中國胸心血管外科臨床雜志, 2010, 17(3): 247-249.

1. 劉迎龍.常見先天性心臟病外科治療的進展.心肺血管病雜志, 2012, 31(4): 353-354.
2. Kazmouz S, Kenny D, Cao QL, et al. Transcatheter closure of secun-dum atrial septal defects. J Invasive Cardiol, 2013, 25(5): 257-264.
3. Liang T, Xiang JZ, Xiao JM, et al. New minimally invasive technique to occlude secundum atrial septal defect in 53 patients. Ann Thorac Surg, 2006, 81(4): 1417-1419.
4. Hongxin L, Wenbin G, Lijun S, et al. Intraoperative device closure of secundum atrial septal defect with a right anterior minithoraco-tomy in 100 patients. J Thorac Cardiovasc Surg, 2007, 134(4): 946-951.
5. 李巔遠, 閆軍, 李守軍, 等.三種不同微創技術與經典外科技術治療房間隔缺損的臨床對比研究.中國胸心血管外科臨床雜志, 2009, 16(1): 31-35.
6. 任建立, 姚建民, 程偉偉, 等.不同微創技術在繼發孔房間隔缺損治療中的應用.中國循證心血管醫學雜志, 2011, 3(2): 97-100.
7. 唐紅, 張爾永, 解俊敏, 等.食管超聲心動圖監測下經胸微創房間隔缺損封堵術.中國胸心血管外科臨床雜志, 2006, 13(5): 349-351.
8. 吳勤, 楊一峰, 徐新華, 等.超聲心動圖在外科微創封堵治療繼發孔房間隔缺損中的應用研究.中南大學學報(醫學版), 2013, 38(6): 602-609.
9. 李建榮, 劉迎龍, 于存濤, 等.右外側小切口剖胸先天性心臟病矯治術近遠期療效觀察.心肺血管病雜志, 2012, 31(4): 377-380.
10. 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(5): 43.
11. 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.
12. 程云閣, 王躍軍, 張泉, 等.完全胸腔鏡下體外循環心臟手術674例臨床分析.中華外科雜志, 2007, 45(22): 1521-1523.
13. 張曉慎, 郭惠明, 劉菁, 等.完全胸腔鏡下與胸骨切口直視房間隔缺損修補術的臨床比較.中華胸心血管外科雜志, 2014, 30(3): 152-155.
14. 劉學剛, 施超, 唐震, 等. 389例先天性心臟病右外側小切口剖胸心內直視手術.心肺血管病雜志, 2012, 31(4): 361-363.
15. 劉迎龍.右外側小切口剖胸在先天性心臟病手術中的應用.中國微創外科雜志, 2004, 4(5): 358-359.
16. 蘇俊武, 凌雁, 李曉鋒, 等.右外側小切口剖胸矯治小兒先天性心臟病1972例.心肺血管病雜志, 2012, 31(4): 358-360.
17. Yao DK, Chen H, Ma LL, et al. Totally endoscopic atrial septal repair with or without robotic assistance: a systematic review and meta-analysis of case series. Heart Lung Circ, 2013, 22(6): 433-440.
18. 唱寬, 谷天祥, 李峰.繼發孔型房間隔缺損三種術式比較分析.寧夏醫學雜志, 2014, 36(4): 323-325.
19. 何發明, 王平凡, 梁志強, 等.右腋下小切口心臟直視手術3012例的臨床應用.中國胸心血管外科臨床雜志, 2010, 17(3): 247-249.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Parasternal Minimally Incision in the Treatment of Atrial Septal Defect

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