Outcome variables of right anterolateral mini-thoracotomy versus complete sternotomy in atrial septal defect closure: A randomized controlled trial

Abstract

Background

Over the last decades, atrial septal defect repair (ASD) as one of the most congenital anomalies has been customarily repaired via sternotomy incision. This technique is associated with very low operative risks and excellent outcomes but with poor esthetic results for the patients. Consequently, right anterolateral mini thoracotomy was invented as a substitute technique aiming for superior cosmetic results. Our study aim was to compare the perioperative outcomes for different approaches.

Methods

Forty patients (15 males, 25 females) with ASDs were randomly assigned to have either one of these two approaches at our institution from March 2013 until May 2016. The patients' ages ranged from 2 to 53 years old. Based on their randomization, group I (20 patients), had right anterolateral mini-thoracotomy (RALT) and group II (20 patients) who had sternotomy for surgical closure of ASD. We collected the different demographic, baseline, perioperative and postoperative characteristics.

Results

The patients in both groups were similar in age preoperative comorbidities and ejection fraction but more females were in RALT group. There was a highly statistically significant prolonged pump-run time in the thoracotomy group than the sternotomy group with p-value = 0.004. Interestingly, in the thoracotomy group, mechanical ventilation time (hours) was shorter with p-value = 0.002. There were similar blood transfusion rate, chest tube drainage, intensive care unit stay and hospital length of stay. However, more wound infection was found in the sternotomy group which was statistically significant (p-value = 0.035). There were no patients requiring conversion to full sternotomy, no residual defect across the atrial septum and all patients were alive on a month follow-up of the hospital discharge.

Conclusions

Right anterolateral mini-thoracotomy is safe, cosmetic, effective and technically feasible and not inferior to the formal median sternotomy to repair ASDs surgically.