Comparison of Short-Term Outcomes: Minimally Invasive Thoracotomy Versus Median Sternotomy for Atrial Septal Defect Closure

TL;DR

This study compares two surgical approaches for closing atrial septal defects and finds that minimally invasive thoracotomy offers better recovery and fewer complications.

Contribution

The study provides new evidence on the short-term benefits of minimally invasive thoracotomy over median sternotomy for ASD closure.

Findings

Minimally invasive thoracotomy resulted in less postoperative pain and faster recovery.

Patients in the minimally invasive group had fewer complications and shorter hospital stays.

Operation times were longer in the minimally invasive group but with better cosmetic outcomes.

Abstract

Objective: This study aimed to compare the early outcomes of atrial septal defect (ASD) surgeries performed using minimally invasive (MI) thoracotomy versus conventional median sternotomy (MS).

Materials and methods: Fifty patients with ASD were included in this study conducted at Bangabandhu Sheikh Mujib Medical University, Dhaka. Fifteen patients underwent MI thoracotomy (Group A), while 35 underwent conventional MS (Group B). Eligible patients were over 16 years old with a single ASD, while those requiring additional interventions were excluded. Demographic data, surgical details, and outcomes were analyzed using SPSS Statistics version 26.0 (IBM Corp. Released 2019. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp.). Pain levels, complications, and other variables were compared using appropriate statistical tests, with a p-value <0.05 considered statistically significant. The study adhered to ethical guidelines and received institutional approval.

Results: Early outcomes of ASD surgeries were analyzed between the two groups. Group A had a younger mean age (31.77 ± 2.64 years) compared to Group B (36.33 ± 12.61 years), although the difference was not statistically significant (p = 0.624). Both groups had similar body mass index (BMI), ASD size, and gender distribution. Group A experienced significantly longer operation times and lower intraoperative body temperatures (p < 0.001). Postoperative drainage was higher in Group A (p = 0.048). However, Group B required more inotropic support (25.71% vs. 13.33%, p = 0.011) and had more significant pain management needs during the recovery period. No significant differences were observed in other outcomes or complications between the groups.

Conclusions: MI thoracotomy for ASD closure offers several advantages over conventional MS, including reduced pain, faster recovery, and shorter hospital stays. Patients in the MI thoracotomy group experienced fewer complications, including atrial fibrillation, arrhythmias, and atelectasis, with no cases of reoperation for bleeding, neurological complications, wound infections, conversions to sternotomy, or mortality. They also required less analgesia and benefited from superior cosmetic outcomes, making this approach a more favorable option, particularly for younger patients.

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