Background And Aim: Transcatheter device closure has become the first treatment option for atrial septal defects (ASD). Surgical ASD closure, although still implemented, is cosmetically inferior to transcatheter closure. This study aimed to evaluate the feasibility as well as short- and long-term clinical outcomes of the right posterolateral minithoracotomy approach for surgical ASD closure.

Methods: In total, 102 consecutive patients underwent posterolateral minithoracotomy for ASD between January 2014 and December 2021 at our center. Early surgical outcomes, cosmetic findings, and skin perception were evaluated over 1 year of postoperative follow-up using a self-satisfaction survey (1: very good, 2: good, 3: normal, 4: not good, 5: bad), Cavendish score, and shoulder joint function (angles of flexion, extension, and abduction).

Results: No patient required conversion to median sternotomy. Only one patient required reoperation due to bleeding. Postoperative echocardiography revealed no residual shunt at discharge in all patients. The mean follow-up period was 3.7 years (range: 0.3-7.1 years), during which the questionnaire was answered by 69 of 98 patients who were evaluated after more than 1 year. The mean self-satisfaction survey scores for cosmetic findings and skin perception were 1.3 ± 0.6 and 1.2 ± 0.5, respectively. The Cavendish score was under Grade 1 in all patients. Shoulder flexion and abduction were normal at 180° in all patients, except one, while extension was normal at 50° in all patients, except three.

Conclusions: Our procedure achieved not only good early surgical outcomes but also excellent long-term cosmetic and shoulder function results.

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http://dx.doi.org/10.1111/jocs.17131DOI Listing

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Article Synopsis
  • The study examines the effectiveness of two surgical techniques, right anterior mini-thoracotomy and right axillary mini-thoracotomy, for closing atrial septal defects in patients at Green City Hospital in Kathmandu from 2016 to 2021.
  • A total of 25 patients were included, with a median age of 26 years and median hospital stay of 4 days, showing no significant differences in recovery times or complications between the two surgical approaches.
  • Results suggest that both methods have similar outcomes, but right axillary mini-thoracotomy may offer benefits like less blood loss during surgery and improved cosmetic results.
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