Baharestani Bahador, Rezaei Shahabedin, Jalili Shahdashti Farshad, Omrani Gholamreza, Heidarali Mona
Interventional Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
J Cardiovasc Thorac Res. 2014;6(3):181-4. doi: 10.15171/jcvtr.2014.008. Epub 2014 Sep 30.
Anterior mini-thoracotomy approach is a good alternative to median sternotomy in Atrial Septal Defect (ASD) repair. Our purpose is to explain the details of our technique and peresent the results.
Seventy five patients with ASD (52 female and 23 male) were operated with anterior mini-thoracotomy approach in our tertiary center between March 2012 and March 2014. The mean age was 14±10 ranged from 2 to 42 years. Outcomes were defined according to cardiopulmonary and aortic cross-clump time, intensive care unit stay time, morbidity, mortality, the size of incision, the amount of post-operative bleeding, need for blood transfusion and reoperation.
Mean Cardiopulmonary bypass time was 49.62 minutes (26 to 105 minutes) and mean aortic cross clamp time was 22.29±6.77 minutes (11 to 47 minutes). The mean amount of blood transfusion was 47.49± 62.22 mm (0 to 200 cc) and the mean chest tube drainage after surgery was 80.17 ±121.06 mm (0 to 600 cc). One patient re-operated for dehiscence of ASD surgical sutures and there was no reoperation for surgical bleeding or tamponade drainage in these patients. In 74 cases the defect was secundum type, in 2 patients it was sinus venosus type and in one with associated partial Anomalous repair.
Anterior thoracotomy approach is safe and may be the surgical technique of choice for secundum ASD repair in all age groups and we can utilize this technique also for more complicated kinds of surgery for instance, sinus venosus type ASD with or without Partial Anomalous Defect.
在房间隔缺损（ASD）修复中，前外侧小切口开胸手术是正中胸骨切开术的良好替代方案。我们的目的是阐述我们的技术细节并展示结果。
2012年3月至2014年3月期间，我们三级医疗中心采用前外侧小切口开胸手术对75例ASD患者（52例女性，23例男性）进行了手术。平均年龄为14±10岁，范围在2至42岁之间。根据心肺转流时间和主动脉阻断时间、重症监护病房停留时间、发病率、死亡率、切口大小、术后出血量、输血需求和再次手术情况来确定结果。
平均体外循环时间为49.62分钟（26至105分钟），平均主动脉阻断时间为22.29±6.77分钟（11至47分钟）。平均输血量为47.49±62.22毫升（0至200毫升），术后平均胸腔闭式引流量为80.17±121.06毫升（0至600毫升）。1例患者因ASD手术缝线裂开而再次手术，这些患者中无因手术出血或心包填塞引流而再次手术的情况。74例患者的缺损为继发孔型，2例为静脉窦型，1例伴有部分异常连接。
前外侧开胸手术方法安全，可能是各年龄组继发孔型ASD修复的手术首选技术，我们也可将此技术用于更复杂的手术，例如伴有或不伴有部分异常连接的静脉窦型ASD。
