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Comparison of Clinical Outcomes of Different Approaches of Atrial Septal Defect Closure: Our Experience

Dharmendra Kumar Srivastava, Professor (junior grade), Department of Cardiothoracic and vascular surgery, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh 226010, India. , Dharmendra Kumar Srivastava , Sudershan Kumar Vijay , Bhuwan Chandra Tiwari , Praveen Kumar Das , Ashish Jha , Naveen Jamwal ,

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Journal of Cardiovascular Medicine and Surgery 4(2):p 88-93, April-June 2018. | DOI: http://dx.doi.org/10.21088/jcms.2454.7123.4218.3

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Abstract

There is a global concern about the aesthetic implications of open surgical repair of ASD among patients and the medical community that forcing patients to seek minimally invasive techniques or transcatheter device closure. We reviewed clinical outcome of different approaches of atrial septal defect closure in fifty nine cases from November 2013 to May 2018 and divided patients into three groups­A­Conventional median sternotomy (64.4% cases). B­ Minimally invasive cardiac surgery (8.47% cases). C­ Percutaneous trans catheter device closure (27.11%). All patients were diagnosed (49 cases as ostium secondum, 09 case sinus venosus, 01 case ostium primum, 07 cases with associated cardiac defects) on TTE &TEE using selection criteria. Aortic cross clamp and cardiopulmonary bypass times were in group A (range of 26­42, 43­94 minutes respectively) and group B (range of 78­90, 92­135 minutes respectively).All the cases of percutaneous trans catheter device closure were performed under local anaesthesia with duration of procedure in range of 40­58 minutes. Cocoon occluder device were commonly used in 12 cases. There were no mortality and no conversions to sternotomy in group B while in group C there were one device migration & one deployment failure. ICU stay and hospital stay was shorter in group C. Surgical device retrieval of migrated device from RVOT via sternotomy approach in 6.2% case. Overall success rate in group A, B, C was 97.3%, 100%, 87.5% respectively. There were no significant cost differences in the entire group. Aesthetically group C & B was better than group A. Overall, improved aesthetic implication, reduced operative pain, and a relatively fast rehabilitation are important considerations for less invasive approaches (PTDC & MICS) of ASD closure. Conventional median sternotomy approach is gold standard if associated cardiac defects, contraindication to MICS, unsuccessful or complicated percutaneous closure of ASD.


 

 

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DOI: http://dx.doi.org/10.21088/jcms.2454.7123.4218.3

Keywords

Minimally Invasive; Transcatheter Closure; Device; Cardiopulmonary Bypass; Device Retrieval.

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