Carstens Henning, Biermann Daniel, Sachweh Jörg, Munz Martin, Hüners Ida, Kozlik-Feldmann Rainer, Hübler Michael
Department of Congenital and Pediatric Heart Surgery, Children's Heart Clinic, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Pediatric Cardiology, Children's Heart Clinic, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Interdiscip Cardiovasc Thorac Surg. 2024 Oct 8;39(4). doi: 10.1093/icvts/ivae128.
Minimally invasive surgical closure of atrial septal defects is gaining widespread acceptance and can be performed via a right midaxillary thoracotomy. In addition, the procedure can be performed in ischaemic cardiac arrest or fibrillation with a core body temperature between 34°C and 36°C.
We present our single-centre results of paediatric patients who underwent surgical atrial septal defect II closure via lateral thoracotomy.
Retrospective analysis. Patients were divided into a cardiac arrest group and a cardiac fibrillation group. All procedures were performed via right midaxillary thoracotomy through a single incision without side ports.
All 37 consecutive patients between March 2019 and August 2022 (median age 3 years; percentile 25th: 2; 75th: 5 years) in both groups were free of mortality and postoperative morbidity such as haemodynamically relevant residual shunt or malignant arrhythmias. Cardiopulmonary bypass time was significantly shorter in the fibrillation group (mean: 34.7 min vs 52.6 min, P = 0.01), and all patients were weaned off the ventilator immediately postoperatively. Length of the intensive care unit stay was not different between the 2 groups. Postoperative hospital stay was significantly longer in patients with cardiac arrest (mean: 5.6 days vs 4.9 days, P = 0.04). Postoperative laboratory parameters did not differ between the 2 groups. All patients were discharged with normal left ventricular function and normalized cardiac enzymes.
Minimally invasive closure of an atrial septal defect during atrial fibrillation is a safe procedure with results comparable to those of an induced cardiac arrest procedure.
微创外科闭合房间隔缺损正获得广泛认可，可通过右腋下开胸术进行。此外，该手术可在体温介于34°C至36°C之间的缺血性心脏骤停或房颤情况下进行。
我们展示了通过侧胸壁切开术进行小儿房间隔缺损II型闭合手术的单中心结果。
回顾性分析。患者分为心脏骤停组和房颤组。所有手术均通过右腋下单一切口开胸，不使用侧孔。
2019年3月至2022年8月期间连续纳入的两组共37例患者（中位年龄3岁；第25百分位数：2岁；第75百分位数：5岁）均无死亡及术后并发症，如血流动力学相关的残余分流或恶性心律失常。房颤组体外循环时间显著更短（平均：34.7分钟对52.6分钟，P = 0.01），且所有患者术后均立即脱机。两组重症监护病房住院时间无差异。心脏骤停患者术后住院时间显著更长（平均：5.6天对4.9天，P = 0.04）。两组术后实验室参数无差异。所有患者出院时左心室功能正常，心肌酶恢复正常。
房颤期间微创闭合房间隔缺损是一种安全的手术，结果与诱导心脏骤停手术相当。
