Minimal access approach for the repair of atrial septal defect: The initial 135 patients

Background. From May 1996 to August 1998 a minimal access approach was used for 135 of 200 consecutive surgical atrial septal defects closures in chil dren through young adults ranging in age from 6 months to 25 years (median 5 years). Methods. A 3.5- to 5-cm midline incision was centered over the xiphoid with division of the xiphoid alone (transxiphoid) or of the lower sternum (mini sternotomy); both groups underwent bicaval venous cannulation through the i ncision. Cardioplegia and aortic cross-clamping were administered through t he incision. Cephalad retraction of the sternum with a fixed-arm retractor aided exposure. Results. There have been no early or late deaths and no bleeding or wound c omplications. No procedure required conversion to a full sternotomy, and no cannulation attempt was abandoned for an alternate site. Crossclamp and ca rdiopulmonary bypass times were equivalent to those in the full sternotomy group. The mean length of hospital stay in the ministernotomy group was 2.7 days. Conclusions. The closure of atrial septal defects can be performed through a transxiphoid or ministernotomy approach, conferring a satisfactory cosmet ic result without compromising the safety or accuracy of the repair. (Ann T horac Surg 2000;70:115-8) (C) 2000 by The Society of Thoracic Surgeons.