Basaran Murat, Kocailik Ali, Ozbek Cihan, Ucak Alper, Kafali Eylul, Us Melih
Goztepe Safak Hospital, Cardiovascular Surgery Clinic, Istanbul, Turkey.
Heart Surg Forum. 2008;11(5):E290-4. doi: 10.1532/HSF98.20081060.
Surgical closure of atrial-septal defects is now associated with low morbidity and mortality rates. We assessed surgical, cosmetic, and psychological results of 3 different surgical approaches to atrial-septal defect repair.
Study participants were 82 patients who underwent surgery for atrial-septal defect. Mean age was 21 +/- 8 years, and the female:male ratio was 23:59. Patients were divided into 3 groups according to the incision used; group 1 (n = 26), partial lower sternotomy; group 2 (n = 34), right anterolateral thoracotomy via a submammary incision, and group 3 (n = 22), conventional median sternotomy.
There was no operative or late mortality. No significant differences between groups were associated with the surgical technique used. Direct closure was the procedure of choice performed in 53 patients (64.6%). In the remaining patients the repair was performed with a pericardial patch (29 patients, 35.4%). One patient in group 1 required conversion to median sternotomy because transoesophageal echocardiography performed at the operating theater revealed a partial anomalous pulmonary venous connection of right pulmonary veins to the inferior vena cava. This patient was excluded from the study group. All patients were symptom free postoperatively, and control echocardiography revealed a trivial shunt in only 1 patient, with a Qp:Qs ratio of 1.3. Rhythm abnormalities, including atrioventricular block, atrial fibrillation, and flutter, were observed in 7 patients but were found to be unrelated to the surgical incision (P = .3). Cardiopulmonary bypass, cross-clamp, and operative times were longer with minimally invasive approaches; but these differences were not statistically significant. Intensive care unit and hospital stay periods were significantly shorter in groups 1 and 2. During the postoperative follow-up period, patients in groups 1 and 2 showed superior results in satisfaction with their cosmetic outcomes.
With the development of minimally invasive techniques that yield surgical results comparable to those of standard techniques, surgeons have changed their focus from survival to cosmetic and psychological outcomes, especially in the repair of simple cardiac defects. Operations performed via limited skin incisions are surgically safe and provide superior cosmetic and psychological results.
房间隔缺损的手术闭合目前与低发病率和死亡率相关。我们评估了3种不同手术方法修复房间隔缺损的手术、美容和心理结果。
研究参与者为82例行房间隔缺损手术的患者。平均年龄为21±8岁，女性与男性比例为23:59。根据所使用的切口将患者分为3组；第1组（n = 26），部分低位胸骨切开术；第2组（n = 34），经乳房下切口的右前外侧开胸术，第3组（n = 22），传统正中胸骨切开术。
无手术或晚期死亡。各手术技术之间未发现显著差异。53例患者（64.6%）选择直接闭合。其余患者采用心包补片进行修复（29例患者，35.4%）。第1组1例患者因手术室经食管超声心动图显示右肺静脉部分异常连接至下腔静脉，需转为正中胸骨切开术。该患者被排除在研究组之外。所有患者术后均无症状，对照超声心动图仅1例患者显示微量分流，Qp:Qs比值为1.3。7例患者观察到节律异常，包括房室传导阻滞、心房颤动和扑动，但发现与手术切口无关（P = 0.3）。微创方法的体外循环、阻断和手术时间较长；但这些差异无统计学意义。第1组和第2组的重症监护病房和住院时间显著缩短。在术后随访期间，第1组和第2组患者对美容效果的满意度更高。
随着微创技术的发展，其手术结果与标准技术相当，外科医生已将关注点从生存转变为美容和心理结果，尤其是在简单心脏缺陷的修复中。通过有限皮肤切口进行的手术在手术上是安全的，并提供更好的美容和心理结果。
