TY - JOUR
T1 - Surgical closure of Atrial Septal Defect (ASD)
T2 - Video-Assisted Cardiac Surgery (VACS) or Median Sternotomy (MS)?
AU - Lin, Pyng Jing
AU - Chang, C. H.
AU - Chu, J. J.
AU - Chang, J. P.
AU - Tsai, K. T.
AU - Liu, H. P.
AU - Hsieh, H. C.
AU - Tsai, F. C.
AU - Hsieh, M. J.
PY - 1996/10
Y1 - 1996/10
N2 - Purpose: Closure of ostium secundum ASD via MS is a simple procedure for most cardiac surgeons. However, MS carries certain possibility of complications. VACS has recently been applied in the management of intracardiac lesions with safety, minimal discomfort, quick functional recuperation, and excellent cosmetic healing. Method: We report our experience in surgical closure of ASD via VACS in 24 patients (10 male & 14 female, aged 1.0 to 60.9, 20.4±17.9) and via MS in 38 patients (16 male & 22 female, aged 0.8 to 62.1, 16.6±16.3). The body weight was 8.5 to 66 Kg (39.3±23.5) in the VACS group and 9.1 to 64.2 kg (40.5±24.3) in the MS group, respectively. The Qp/Qs was 1.5 to 4.8 (3.0±1.0) and 1.5 to 4.0 (2.1±0.8) respectively (p<0.005). In the VACS group, the operations were performed through right anterior minithoracotomy and guided by video-assisted endoscope under femoro-femoral or femoro-right atrial extracorporeal circulation. The aorta was not cross-clamped and the myocardium was protected by continuous coronary perfusion with hypothermic fibrillatory arrest. Direct or patch closure of the ASD was performed successfully in all patients. Result: The duration of extracorporeal circulation [27 to 126 minutes (63.4±25.5) and 14 to 70 (32±22), respectively, p<0.005] and operation [1.7 to 4.6 hours (2.7±0.8) and 1.4 to 4.4 (2.2±0.7), respectively, p<0.01] were significantly longer in the VACS group. However, the postoperative drainage index [first 6-hour drainage amount (ml)/ body surface (M2), 54±8 and 111±9, respectively, p<0.001] was less in the VACS group. All the patients recovered from the surgery rapidly. The postoperative length of stay was significantly shorter in the VACS group [2.0 to 9.0 days (6.4±2.4) and 4.0 to 24.0 days (9.2±4.0), respectively, p<0.01]. Follow-up was complete on all patients from 1 month to 5 months (mean 2.3) in the VACS group and 10 to 21 months (mean 16.5) in the MS group. There were no wound infections or neurological complications. Follow-up transthoracic echocardiographic examination did not show any residual shunt in any patients. All the patients were found to be in the New York Heart Association functional class I or II. Conclusions: Our results suggest that VACS is a good option for surgical closure of ASD. We now use VACS to repair ASD routinely.
AB - Purpose: Closure of ostium secundum ASD via MS is a simple procedure for most cardiac surgeons. However, MS carries certain possibility of complications. VACS has recently been applied in the management of intracardiac lesions with safety, minimal discomfort, quick functional recuperation, and excellent cosmetic healing. Method: We report our experience in surgical closure of ASD via VACS in 24 patients (10 male & 14 female, aged 1.0 to 60.9, 20.4±17.9) and via MS in 38 patients (16 male & 22 female, aged 0.8 to 62.1, 16.6±16.3). The body weight was 8.5 to 66 Kg (39.3±23.5) in the VACS group and 9.1 to 64.2 kg (40.5±24.3) in the MS group, respectively. The Qp/Qs was 1.5 to 4.8 (3.0±1.0) and 1.5 to 4.0 (2.1±0.8) respectively (p<0.005). In the VACS group, the operations were performed through right anterior minithoracotomy and guided by video-assisted endoscope under femoro-femoral or femoro-right atrial extracorporeal circulation. The aorta was not cross-clamped and the myocardium was protected by continuous coronary perfusion with hypothermic fibrillatory arrest. Direct or patch closure of the ASD was performed successfully in all patients. Result: The duration of extracorporeal circulation [27 to 126 minutes (63.4±25.5) and 14 to 70 (32±22), respectively, p<0.005] and operation [1.7 to 4.6 hours (2.7±0.8) and 1.4 to 4.4 (2.2±0.7), respectively, p<0.01] were significantly longer in the VACS group. However, the postoperative drainage index [first 6-hour drainage amount (ml)/ body surface (M2), 54±8 and 111±9, respectively, p<0.001] was less in the VACS group. All the patients recovered from the surgery rapidly. The postoperative length of stay was significantly shorter in the VACS group [2.0 to 9.0 days (6.4±2.4) and 4.0 to 24.0 days (9.2±4.0), respectively, p<0.01]. Follow-up was complete on all patients from 1 month to 5 months (mean 2.3) in the VACS group and 10 to 21 months (mean 16.5) in the MS group. There were no wound infections or neurological complications. Follow-up transthoracic echocardiographic examination did not show any residual shunt in any patients. All the patients were found to be in the New York Heart Association functional class I or II. Conclusions: Our results suggest that VACS is a good option for surgical closure of ASD. We now use VACS to repair ASD routinely.
UR - https://www.scopus.com/pages/publications/0010369191
M3 - 文章
AN - SCOPUS:0010369191
SN - 1931-3543
VL - 110
SP - 207S
JO - Chest
JF - Chest
IS - 4 SUPPL.
ER -