Totally Thoracoscopic Versus Open Surgery for Closure of Atrial Septal Defect: Propensity-Score Matched Comparison

2014 ◽  
Vol 17 (4) ◽  
pp. 227 ◽  
Author(s):  
Zhe Zheng ◽  
Hua Kun ◽  
Xu Xuezeng ◽  
Chen Yunge ◽  
Ma Zengshan ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Propensity Score ◽  
Atrial Septal Defect ◽  
Open Surgery ◽  
Septal Defect ◽  
Thoracoscopic Surgery ◽  
Median Sternotomy ◽  
Robotic Assistance ◽  
Thoracoscopic Approach ◽  
Significant Difference

<p>The purpose of this study is to compare early clinical outcomes of surgical repair for isolated atrial septal defect (ASD) with a totally thoracoscopic approach without robotic assistance versus a conventional open procedure.</p><p>Between September 2010 and June 2012, 254 consecutive patients with isolated ASD underwent totally thoracoscopic surgery without robotic assistance in seven institutions participating in the nationwide multi-centered registry in China. During the same period, these patients were matched using propensity score methodology with 254 patients who had accepted conventional open surgery through a median sternotomy. The early in-hospital results between the two groups were analyzed and compared.</p><p>The patient age was 26.8 � 14.0 years and weight was 52.9 � 16.9 kg in the totally thoracoscopic group. The totally thoracoscopic surgery required longer aortic clamp time (32.1 � 17.3 minutes versus 28.3 � 16.7 minutes, <i>P</i> = .01); shorter length of stay in the intensive care unit (25.3 � 12.2 hours versus 34.8 � 24.4 hours, <i>P</i> = .001); shorter length of stay in hospital (6.5 � 6.3 days versus 7.9 � 6.4 days, <i>P</i> = .008); and shorter mechanical ventilation time (8.3 � 5.0 hours versus 11.4 � 14.8 hours, <i>P</i> = .04). The cardiopulmonary bypass (CPB) time (62.7 � 29.3 minutes versus 61.5 � 28.0 minutes, <i>P</i> = .64) showed no significant difference between the two groups. The totally thoracoscopic group had significantly less postoperative chest tube drainage (322.1 � 213.7 mL versus 462.8 � 398.4 mL, <i>P</i> = .001). The intraoperative (35.4% versus 38.6%, <i>P</i> = .46) and postoperative blood products usage (20.9% versus 21.3%, <i>P</i> = .91) showed no significant difference between the two groups.</p><p>There also was no significant difference in mortality and major in-hospital complications between the two groups. The early outcomes for treatment of isolated ASD were similar between the totally thoracoscopic group conventional open operation performed through median sternotomy, despite a longer aortic clamp time in the totally thoracoscopic group.</p>

scholarly journals Right Anterolateral Thoracotomy an Alternative to Median Sternotomy for Closure of Atrial Septal Defect: A Cosmetic Approach in Young Females

2015 ◽  
Vol 12 (1) ◽  
pp. 21-25
Author(s):  
Ravi Kumar Baral ◽  
Bhagawan Koirala
Keyword(s):  
Minimally Invasive ◽  
Atrial Septal Defect ◽  
Septal Defect ◽  
Demographic Data ◽  
Median Sternotomy ◽  
Young Females ◽  
Anterolateral Thoracotomy ◽  
Significant Difference ◽  
Asd Closure ◽  
Duration Of Operation

Background and Aims: Atrial septal defect operation is a safe and low-risk procedure. Cosmetic results have been an important issue, so right anterolateral thoracotomy approach has been used for repair. We present minimally invasive ASD closure via limited right anterolateral thoracotomy, as our early experience in road of minimally invasive cardiac surgery. Methods: This study was done in the Manmohan Cardiothoracic and Transplant Center in the time period of 2012 to 2013. The study included 70 patients aged 15 – 35 years old (22.1±5.5) admitted for surgical repair of their secundum atrial septal defects. The patients were randomly allocated into one of two groups according to the approach used in their operation. Right anterolateral thoracotomy(RALT) group included 35 patients operated via right anterolateral thoracotomy.and median sternotomy(MS) group included 35 patients operated via the median sternotomy. Result: Of 70 patients only 63 patients meet the criteria for analysis. There was no statistically significant difference between the 2 groups regarding their demographic data and duration of operation. Postoperative pleural/pericardial effusion and pneumothorax occurred in 2.1% of patients in MS and 6.6% in Right anterolateral thoracotomygroup (p= 0.001). Total in hospital pain score was high in sternotomy group than thoracotomy group, but did not reach statistically significant values. There was no operative or late mortality or morbidity in the early follow-up (range, 1 m to 2 years, mean 1.34 yrs). Conclusion: RALT is a safe and effective alternative approach to MS incision for ASD closure. DOI: http://dx.doi.org/10.3126/njh.v12i1.12340 Nepalese Heart Journal Vol.12(1) 2015: 21-25

scholarly journals Right Anterolateral Thoracotomy an Alternative to Median Sternotomy for Closure of Atrial Septal Defect: A Cosmetic Approach in Young Females

2015 ◽  
Vol 12 (1) ◽  
Author(s):  
Ravi Kumar Baral ◽  
Bhagawan Koirala
Keyword(s):  
Minimally Invasive ◽  
Atrial Septal Defect ◽  
Septal Defect ◽  
Demographic Data ◽  
Median Sternotomy ◽  
Young Females ◽  
Anterolateral Thoracotomy ◽  
Significant Difference ◽  
Asd Closure ◽  
Duration Of Operation

Background and Aims: Atrial septal defect operation is a safe and low-risk procedure. Cosmetic results have been an important issue, so right anterolateral thoracotomy approach has been used for repair. We present minimally invasive ASD closure via limited right anterolateral thoracotomy, as our early experience in road of minimally invasive cardiac surgery. Methods: This study was done in the Manmohan Cardiothoracic and Transplant Center in the time period of 2012 to 2013. The study included 70 patients aged 15 – 35 years old (22.1±5.5) admitted for surgical repair of their secundum atrial septal defects. The patients were randomly allocated into one of two groups according to the approach used in their operation. Right anterolateral thoracotomy(RALT) group included 35 patients operated via right anterolateral thoracotomy.and median sternotomy(MS) group included 35 patients operated via the median sternotomy. Result: Of 70 patients only 63 patients meet the criteria for analysis. There was no statistically significant difference between the 2 groups regarding their demographic data and duration of operation. Postoperative pleural/pericardial effusion and pneumothorax occurred in 2.1% of patients in MS and 6.6% in Right anterolateral thoracotomygroup (p= 0.001). Total in hospital pain score was high in sternotomy group than thoracotomy group, but did not reach statistically significant values. There was no operative or late mortality or morbidity in the early follow-up (range, 1 m to 2 years, mean 1.34 yrs). Conclusion: RALT is a safe and effective alternative approach to MS incision for ASD closure.Nepalese Heart Journal | Jan 2015 | Volume 12 | No.1Page : 21-25

scholarly journals Triport periareolar thoracoscopic surgery versus right minithoracotomy for repairing atrial septal defect in adults

2020 ◽  
Author(s):  
Xiang-Xiang Zheng ◽  
Ze-Yu Wang ◽  
Lu-Yao Ma ◽  
Hong- Liu ◽  
Huan- Liu ◽  
...  
Keyword(s):  
Atrial Septal Defect ◽  
Septal Defect ◽  
Rating Scale ◽  
Thoracoscopic Surgery ◽  
Operation Time ◽  
Numeric Rating Scale ◽  
Hospital Death ◽  
Aortic Cross Clamp Time ◽  
Atrial Septal Defect Closure ◽  
Satisfaction Scale

Abstract OBJECTIVES Our goal was to investigate the safety and feasibility of triport periareolar thoracoscopic surgery (TPTS) and its advantages in repairing adult atrial septal defect. METHODS Between January 2017 and January 2020, a total of 121 consecutive adult patients underwent atrial septal defect closure in our institution. Of these, 30 patients had TPTS and 31 patients had a right minithoracotomy (RMT). Operational data and clinical outcomes were compared between the 2 groups. RESULTS The total operation time, cardiopulmonary bypass time and aortic cross-clamp time in the TPTS group were slightly longer than those in the RMT group, but there were no differences between the 2 groups. Compared with the RMT group, the TPTS group showed a decrease in the volume of chest drainage in 24 h (98.6 ± 191.2 vs 222.6 ± 217.2 ml; P = 0.032) and a shorter postoperative hospital stay (6.5 ± 1.5 vs 8.0 ± 3.7 days; P = 0.042). The numeric rating scale on postoperative day 7 was significantly less in the TPTS group than in the RMT group (2.82 ± 1.14 vs 3.56 ± 1.42; P = 0.034). The patient satisfaction scale for the cosmetic results in the TPTS group was significantly higher than in the RMT group (4.68 ± 0.55 vs 4.22 ± 0.76; P = 0.012). No differences were found in postoperative complications. No in-hospital death or major adverse events occurred in the 2 groups. CONCLUSIONS TPTS is safe and feasible for the closure of adult atrial septal defect. Compared with RMT, it has been associated with less pain and better cosmetic outcomes.

scholarly journals Endoscopic closure of a bronchopleural fistula after pneumonectomy with the Amplatzer occluder: a step forward?

2019 ◽  
Author(s):  
Igor Ya Motus ◽  
Alexander V Bazhenov ◽  
Rauf T Basyrov ◽  
Anna S Tsvirenko
Keyword(s):  
Atrial Septal Defect ◽  
Septal Defect ◽  
Thoracoscopic Surgery ◽  
Bronchopleural Fistula ◽  
Underlying Disease ◽  
Severe Exacerbation ◽  
Video Assisted ◽  
Endoscopic Closure ◽  
Amplatzer Device ◽  
Amplatzer Occluder

Abstract OBJECTIVES A bronchopleural fistula after pneumonectomy is a relatively rare but very serious complication. The development of endoscopic methods of treatment opens a new page in treating this condition. The goal of this paper was to confirm that the atrial septal defect Amplatzer device can be used for bronchopleural fistula closure in properly selected patients. METHODS A retrospective study of 13 patients with bronchopleural fistula after pneumonectomy was performed. There were 11 men and 2 women aged 26–70 years. Right-sided fistulas occurred in 10 patients and left-sided fistulas occurred in 3. The underlying disease was lung cancer in 7 patients and pulmonary tuberculosis in 6. Video-assisted thoracoscopic surgery (N = 7) and open-window thoracostomy (N = 6) were used to treat the empyema. To treat occlusion of the bronchial fistulas, we used Amplatzer atrial septal defect occluders originally intended for closure of ventricular and interatrial septal defects. The occluder was inserted from the bronchus by flexible bronchoscopy with the patient under local anaesthesia, with the help of video-assisted thoracoscopy or through a window thoracostomy from the pleural cavity. RESULTS We noted 3 complications after the procedure. In 2 patients, displacement of the occluders required re-installation in 1 patient and latissimus dorsi muscle coverage in the other. In the third patient, the occluder became dislodged during severe exacerbation of tuberculosis that occurred after the patient violated the treatment regimen. She died of tuberculosis 6 months after the occluder was inserted. The course in the remaining 10 patients was uneventful. CONCLUSIONS Our experience suggests that the use of an atrial septal defect occluder for the treatment of a bronchial fistula after pneumonectomy is a reliable option.

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