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A 5-year experience with surgical repair of atrial septal defect employing limited exposure

Published online by Cambridge University Press:  19 August 2008

Junaid H. Khan ,
Doff B. McElhinney ,
V. Mohan Reddy  and
Frank L. Hanley
Junaid H. Khan
Affiliation:
Division of Cardiothoracic Surgery, University of California, San Francisco, CA, USA
Doff B. McElhinney
Affiliation:
Division of Cardiothoracic Surgery, University of California, San Francisco, CA, USA
V. Mohan Reddy
Affiliation:
Division of Cardiothoracic Surgery, University of California, San Francisco, CA, USA
Frank L. Hanley*
Affiliation:
Division of Cardiothoracic Surgery, University of California, San Francisco, CA, USA
*
Frank L. Hanley, MD, UCSF Medical Center, 505 Parnassus Avenue M593, San Francisco CA 94143–0118, USA
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Abstract

Background

There has been a trend in recent years towards less invasive therapy for many congenital cardiac malformations. For the past 5 years, we have employed a technique of limited surgical exposure when repairing atrial defects within the oval fossa.

Methods

Over the 5-year period from July 1992 to August 1997, 115 consecutive patients underwent surgical repair of an isolated atrial septal defect in the region of the oval fossa by a single surgeon. The patients had a limited midline skin incision starting at the line of the nipples and extending inferiorly across 2 to 3 intercostal spaces. A partial sternotomy was performed, sparing the manubrium. Standard instruments and cannulation techniques were used for cardiopulmonary bypass and fibrillatory arrest.

Results

There were no deaths and no major complications. The median time to extubation after leaving the operating room was 3 hours (30 minutes to 8 days). Mediastinal drains were removed the morning after surgery. The median stay in the intensive care unit was 7 hours (3 hours to 10 days), and patients were discharged from the hospital a median of 4 days postopera-tively (2 to 23 days).

Conclusions

This approach using limited exposure can be applied safely without any new instruments and without peripheral incisions or sites of vascular access, while providing a comfortable exposure for the surgeon and achieving a cosmetically superior result for the patient.

Keywords

minimally invasive surgical procedurescongenital heart defectscritical pathways
Type
Original Articles
Information
Cardiology in the Young , Volume 9 , Issue 6 , November 1999 , pp. 572 - 576
Copyright
Copyright © Cambridge University Press 1999

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