New minimally invasive technique to occlude secundum atrial septal defect in 53 patients.

BACKGROUND

Conventional surgical atrial septal defect (ASD) closure requires cardiopulmonary bypass, whereas percutaneous transcatheter closure is limited by maximal defect size of 34 mm and access to the neck. We describe a new minimally invasive approach using a right minithoracotomy to deploy an occluder without cardiopulmonary bypass.

METHODS

Between October 2004 and April 2005, 53 secundum ASDs were closed by this method. Through a 3-cm incision in the right fourth intercostal space, a minithoracotomy exposes the right atrium to facilitate deployment of the septal closure device. The age of the patients was from 2 to 61 years. The ASD size was 12 to 39 mm.

RESULTS

All ASDs were successfully closed with a mean device size of 33.1 +/- 8 mm (range, 16 to 46 mm). The procedure duration was 30 to 60 minutes. All patients were extubated on table, with less than a 1-day stay in the intensive care unit. The hospital stay was 3 to 7 days. There was no postoperative mortality. At mean follow-up of 1 to 8 months, there were no major morbidities. One patient had minimal residual shunt that resolved 1 month later.

CONCLUSIONS

This new minimally invasive method of secundum ASD closure is safe and cosmetically superior to conventional surgery. Early results are encouraging.