Key result
Right anterior mini thoracotomy increases CPB time by ~10 minutes vs median sternotomy for ASD closure.
Why the study?
Due to favourable clinical outcomes, minimally invasive ASD closure is gaining popularity, prompting a comparison between mini thoracotomy with total peripheral cannulation and median sternotomy in Nepal.
Does right anterior mini thoracotomy with total peripheral cannulation improve clinical outcomes compared to median sternotomy in patients undergoing Atrial Septal Defect closure?
RCT (n=62)
Randomized
No
Does right anterior mini thoracotomy with total peripheral cannulation improve clinical outcomes compared to median sternotomy in patients undergoing Atrial Septal Defect closure?
Absolute Event Rate: 43.97% vs 34.42%
p-value: p=0.002
Right anterior mini thoracotomy is a safe and cosmetically acceptable alternative to median sternotomy for ASD closure, resulting in less post-operative bleeding despite longer procedural times.
May increase bypass time in ASD closure; leaves open whether minimally invasive approaches improve outcomes.
Background: Atrial Septal Defect (ASD) closure is a common cardiac surgical procedure performed worldwide. Due to favourable clinical outcome, minimal invasive approach is becoming popular. Hence this study was conducted to compare the outcome of two surgical approaches, median sternotomy and mini thoracotomy with total peripheral cannulation, in a developing country Nepal. Methods: A prospective study of 62 ASD patients, randomized to undergo surgical closure either via right anterior mini thoracotomy or median sternotomy was conducted and followed up over three years. The clinical outcome parameters like intensive care unit stay, hospital stay, post-operative duration of ventilation, cardiopulmonary bypass time, aortic cross clamp time, mediastinal drainage, size of scar and complication were compared between two groups. Results: Cardiopulmonary bypass time and aortic cross clamp time were significantly longer in right anterior mini thoracotomy group as compared to median sternotomy group (43.97 min ± 12.70 min vs 34.42 min ± 10.42 min and 25.13 min ± 7.82 min vs 19.48 min ± 6.93 min respectively, p-value 0.05). There was no significant difference in duration of surgery (2.75 hrs ± 0.43 hrs vs 2.56 hrs ± 0.41 hrs, p-value = 0.09), post-operative ventilation (2.90 hrs ± 1.22 hrs and 2.88 hrs ± 1.07 hrs, p-value = 0.96) between two groups. Post-operative mediastinal drainage was significantly less in right anterior mini thoracotomy group (214.52 ml ± 91.79 ml vs 284.03 ml ± 158.91 ml, p-value = 0.04). There was no significant difference in ICU stay and hospital stay. Conclusion: Atrial septal defect can be safely closed by right anterior mini thoracotomy with a small, cosmetically acceptable submammary scar with less pain and bleeding.
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Khakural et al. (2020) conducted an RCT in Ostium secundum atrial septal defect (n=62). Right anterior mini thoracotomy with total peripheral cannulation vs. Median sternotomy was evaluated on Cardiopulmonary bypass time (minutes) (p=0.002). Right anterior mini thoracotomy significantly increased cardiopulmonary bypass time (43.97 vs 34.42 min) compared to median sternotomy for atrial septal defect closure.
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