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Hardman G, Zacharias J. Minimal-Access Atrial Septal Defect (ASD) Closure. J Cardiovasc Dev Dis 2023; 10:jcdd10050206. [PMID: 37233173 DOI: 10.3390/jcdd10050206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/01/2023] [Accepted: 05/07/2023] [Indexed: 05/27/2023] Open
Abstract
Progress towards the development and adoption of minimally invasive techniques in cardiac surgery has been slower than that seen in other surgical specialties. Congenital heart disease (CHD) patients represent an important population within cardiac disease, of which atrial septal defect (ASD) is one of the most common diagnoses. Management of ASD encompasses a range of minimal-access and minimally invasive approaches, including transcatheter device closure, mini-sternotomy, thoracotomy, video-assisted, endoscopic, and robotic approaches. In this article, we will discuss the pathophysiology of ASD, along with diagnosis, management, and indications for intervention. We will review the current evidence supporting minimally invasive and minimal-access surgical ASD closure in the adult and paediatric patient, highlighting peri-operative considerations and areas for further research.
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Affiliation(s)
- Gillian Hardman
- Department of Cardiothoracic Surgery, Blackpool Victoria Hospital, Blackpool FY3 8NR, UK
| | - Joseph Zacharias
- Department of Cardiothoracic Surgery, Blackpool Victoria Hospital, Blackpool FY3 8NR, UK
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Atalay A, Yilmaz M, Turkcan BS, Ecevit AN, Ozler B, Azak E, Ozisik K. Can Right Infra-Axillary Vertical Thoracotomy Make a Big Difference in Surgical Technique Preference? Heart Lung Circ 2022; 31:1419-1424. [PMID: 35871132 DOI: 10.1016/j.hlc.2022.06.661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/04/2022] [Indexed: 11/16/2022]
Abstract
AIM Minimally invasive techniques in the surgical treatment of congenital heart diseases have gained popularity recently. Right infra-axillary vertical thoracotomy (RIAVT) is one of these techniques. The aim of this study is to investigate the postoperative morbidity and cosmetic results of the right infraaxillary thoracotomy technique and compare them with the results in the literature. METHOD All patients who had undergone cardiac surgery using RIAVT at the Ankara City Hospital Pediatric Cardiovascular Surgery Clinic between 2019 and 2021 were enrolled in the study. Pre-operative echocardiographic diagnoses, intraoperative surgical data and post-operative morbidity data of the patients was obtained. In addition, surgical incision length was measured and recorded for the evaluation of cosmetic outcome. This data was then compared with data from similar studies in the literature. RESULT Between January 2019 and December 2021, 59 patients were operated using RIAVT. Of the RIAVT patients, 45 (76%) were female and 14 (24%) were male. The mean weight of the patients was 22.38±12.48 kg. Although the youngest patient was a 5-month-old infant weighing 4 kg, the oldest one was 15-years-old weighing 57 kg. Isolated secundum atrial septal defect (ASD) repair (primary or patch) was performed in 47 patients. 1 patient with Primum ASD and mitral cleft, 1 patient with secundum ASD and perimembranous ventricular septal defect (VSD) repair, 9 patients with high venosum ASD and PAPVC, and 1 patient with a discrete subaortic membrane were operated on. The surgical incision length was between 4 to 5 cm. CONCLUSION RIAVT is an important surgical alternative to median sternotomy in selected cases with certain pathologies. It can be performed safely in various congenital heart anomalies and provides excellent functional and cosmetic results in the long-term when compared to other surgical methods.
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Affiliation(s)
- Atakan Atalay
- Department of Congenital Heart Surgery, Ankara City Hospital, Ankara, Turkey.
| | - Mustafa Yilmaz
- Department of Congenital Heart Surgery, Ankara City Hospital, Ankara, Turkey
| | - Başak Soran Turkcan
- Department of Congenital Heart Surgery, Ankara City Hospital, Ankara, Turkey
| | - Ata Niyazi Ecevit
- Department of Congenital Heart Surgery, Ankara City Hospital, Ankara, Turkey
| | - Bilfer Ozler
- Department of Anesthesiology and Reanimation, Ankara City Hospital, Ankara, Turkey
| | - Emine Azak
- Department of Pediatric Cardiology, Ankara City Hospital, Ankara, Turkey
| | - Kanat Ozisik
- Department of Congenital Heart Surgery, Ankara City Hospital, Ankara, Turkey
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Konstantinov IE, Kotani Y, Buratto E, Schulz A, Ivanov Y. Minimally invasive approaches to atrial septal defect closure. JTCVS Tech 2022; 14:184-190. [PMID: 35967196 PMCID: PMC9366208 DOI: 10.1016/j.xjtc.2022.02.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 02/17/2022] [Indexed: 10/29/2022] Open
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Abstract
OBJECTIVES The mini right axillary thoracotomy is an alternative surgical approach to repair certain congenital heart defects. Quality-of-life metrics and clinical outcomes in children undergoing either the right axillary approach or median sternotomy were compared. METHODS Patients undergoing either approach for the same defects between 2018 and 2020 were included. Demographic details, operative data, and outcomes were compared between both groups. An abbreviated quality of life questionnaire based on the Infant/Toddler/Child Health Questionnaires focused on the patient's global health, physical activity, and pain/discomfort was administered to all parents/guardians within two post-operative years. RESULTS Eighty-seven infants and children underwent surgical repair (right axillary thoracotomy, n = 54; sternotomy, n = 33) during the study period. There were no mortalities in either group. The right axillary thoracotomy group experienced significantly decreased red blood cell transfusion, intubation, intensive care, and hospital durations, and earlier chest tube removal. Up to 1 month, parents' perception of their child's degree and frequency of post-operative pain was significantly less after the right axillary thoracotomy approach. No difference was found in the patient's global health or physical activity limitations beyond a month between the two groups. CONCLUSIONS With the mini right axillary approach, surrogates of faster clinical recovery and hospital discharge were noted, with a significantly less perceived degree and frequency of post-operative pain initially, but without the quality of life differences at last follow-up. While providing obvious cosmetic advantages, the minimally invasive right axillary thoracotomy approach for the surgical repair of certain congenital heart lesions is a safe alternative to median sternotomy.
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Zhang QL, Liu JF, Xie WP, Cao H, Chen Q. The Effect of WeChat on Parental Care Burden, Anxiety, and Depression in Children after CHD Surgery during COVID-19 Pandemic. Appl Clin Inform 2021; 12:768-773. [PMID: 34407558 DOI: 10.1055/s-0041-1733850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVES This study aimed to explore the effect of applying WeChat in the follow-up and health education of children after congenital heart disease (CHD) surgery during the coronavirus disease 2019 (COVID-19) epidemic. METHODS Data from 135 children were retrospectively analyzed. The care burden, anxiety, depression, and satisfaction of the parents of patients at home were analyzed and compared. RESULTS One month after discharge, the Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), Zarit Burden Interview (ZBI), and Patient Satisfaction Questionnaire-18 scores of the WeChat follow-up group were significantly better than those of the outpatient follow-up group (p < 0.05). Compared with the discharge time, the SAS, SDS, and ZBI scores were significantly improved in the WeChat follow-up group but not in the outpatient follow-up group (p < 0.05). CONCLUSION During the COVID-19 epidemic, the application of WeChat to the follow-up management of children after CHD surgery can effectively reduce care burden and relieve anxiety and depression in parents at home. It can also improve the satisfaction of parents with medical treatment.
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Affiliation(s)
- Qi-Liang Zhang
- Department of Cardiac Surgery, Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.,Cardiac Surgery, Fujian Children's Hospital, Fuzhou, China.,Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Jian-Feng Liu
- Department of Cardiac Surgery, Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.,Cardiac Surgery, Fujian Children's Hospital, Fuzhou, China.,Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Wen-Peng Xie
- Department of Cardiac Surgery, Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.,Cardiac Surgery, Fujian Children's Hospital, Fuzhou, China.,Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Hua Cao
- Department of Cardiac Surgery, Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.,Cardiac Surgery, Fujian Children's Hospital, Fuzhou, China.,Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Qiang Chen
- Department of Cardiac Surgery, Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.,Cardiac Surgery, Fujian Children's Hospital, Fuzhou, China.,Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
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Li C, Gong X, Huang J, Zhu L, Dong W, Zhang M, Liu Y, Xu Z. Effects of repairing ventricular septal defects with right vertical infra-axillary mini-incision on lung function and postoperative analgosedation. Exp Ther Med 2021; 21:302. [PMID: 33717245 PMCID: PMC7885067 DOI: 10.3892/etm.2021.9733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 01/06/2021] [Indexed: 11/06/2022] Open
Abstract
The present study aimed to assess the effects of repairing ventricular septal defects (VSDs) with right vertical infra-axillary mini-incision (RVAI). A total of 116 patients with VSDs were prospectively enrolled and underwent cardiac surgery between June 2017 and December 2018 at the cardiac intensive care unit of Shanghai Children's Medical Center (Shanghai, China). Of these, 58 patients underwent the RVAI procedure and 58 patients matched 1:1 underwent the standard median sternotomy incision (MSI) procedure and were designated as the control group. The demographic data and clinical outcomes intra- and postoperatively were compared. A bedside lung ultrasound was performed to evaluate the degree of lung injury and the number of B-lines was quantified and compared between the two groups. The sedation and analgesia levels were also assessed after the operation. No significant difference was identified between the two groups regarding the overall cardiopulmonary bypass or aortic cross-clamp time. All patients were extubated within 8 h. The RVAI group had shorter incision lengths (median, 4.6 cm) and less drainage (median, 15 ml) than the MSI group. Furthermore, compared to the MSI group, the RVAI group had a significantly higher number of B-lines in the right lung regions immediately after surgery and at 12 h postsurgery (24.1 and 5.2%, respectively) but eventually exhibited no differences at 24 and 36 h postsurgery; by contrast, there were no differences in the left lung regions. The bedside bispectral index score and the Face, Legs, Activity, Cry, Consolability scale score exhibited no significant differences after the operation. In conclusion, the RVAI procedure appears to be a safe alternative for repairing VSDs in addition to satisfactory cosmetic results and the incision does not interfere with postoperative analgosedation.
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Affiliation(s)
- Chunxiang Li
- Department of Cardiac Intensive Care Unit, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai 200127, P.R. China
| | - Xiaolei Gong
- Department of Cardiac Intensive Care Unit, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai 200127, P.R. China
| | - Jihong Huang
- Department of Cardiac Intensive Care Unit, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai 200127, P.R. China
| | - Limin Zhu
- Department of Cardiac Intensive Care Unit, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai 200127, P.R. China
| | - Wei Dong
- Department of Cardiac Intensive Care Unit, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai 200127, P.R. China
| | - Mingjie Zhang
- Department of Cardiac Intensive Care Unit, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai 200127, P.R. China
| | - Yujie Liu
- Department of Cardiac Intensive Care Unit, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai 200127, P.R. China
| | - Zhuoming Xu
- Department of Cardiac Intensive Care Unit, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai 200127, P.R. China
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Onan B, Onan IS. Early Results of Robotically Assisted Congenital Cardiac Surgery: Analysis of 242 Patients. Ann Thorac Surg 2020; 112:2020-2027. [DOI: 10.1016/j.athoracsur.2020.10.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 09/26/2020] [Accepted: 10/19/2020] [Indexed: 12/01/2022]
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Luo ZR, Chen Q, Yu LL, Chen LW, Huang ZY. Comparative Study between Surgical Repair of Atrial Septal Defect via Median Sternotomy, Right Submammary Thoracotomy, and Right Vertical Infra-Axillary Thoracotomy. Braz J Cardiovasc Surg 2020; 35:285-290. [PMID: 32549099 PMCID: PMC7299584 DOI: 10.21470/1678-9741-2019-0096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To compare the results of surgical repair via median sternotomy, right submammary thoracotomy, and right vertical infra-axillary thoracotomy for atrial septal defect (ASD). Methods This is a retrospective analysis of the relative perioperative and postoperative data of 136 patients who underwent surgical repair for ASD with the abovementioned three different treatments in our hospital from June 2014 to December 2017. Results The results of the surgeries were all satisfactory in the three groups. No statistically significant difference was found in operative time, duration of cardiopulmonary bypass, blood transfusion amount, postoperative mechanical ventilation time, duration of intensive care unit, length of hospital stay, and hospital costs. However, the median sternotomy group had the longest incision. Meanwhile, there was no significant difference in postoperative complications. Conclusion All three types of surgical incisions can be safely and effectively used to repair ASD. The treatments via right submammary thoracotomy and right vertical infra-axillary thoracotomy have advantages over the treatment via median sternotomy in cosmetic results and should be the recommended options.
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Affiliation(s)
- Zeng-Rong Luo
- Fujian Medical University Union Hospital Department of Cardiovascular Surgery Fujian People's Republic of China Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, People's Republic of China
| | - Qiang Chen
- Fujian Medical University Union Hospital Department of Cardiovascular Surgery Fujian People's Republic of China Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, People's Republic of China
| | - Ling-Li Yu
- Fujian Medical University Union Hospital Department of Cardiovascular Surgery Fujian People's Republic of China Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, People's Republic of China
| | - Liang-Wan Chen
- Fujian Medical University Union Hospital Department of Cardiovascular Surgery Fujian People's Republic of China Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, People's Republic of China
| | - Zhong-Yao Huang
- Fujian Medical University Union Hospital Department of Cardiovascular Surgery Fujian People's Republic of China Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, People's Republic of China
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Transcatheter device closure of atrial septal defects guided completely by transthoracic echocardiography: A single cardiac center experience with 152 cases. Anatol J Cardiol 2019; 20:330-335. [PMID: 30504733 PMCID: PMC6287434 DOI: 10.14744/anatoljcardiol.2018.90502] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Objective: This study aimed to assess the safety and feasibility of transcatheter device closure of atrial septal defects (ASDs) guided completely by transthoracic echocardiography (TTE). Methods: A total of 152 patients underwent transcatheter device closure of ASDs guided completely by TTE in our center from September 2014 to June 2017. We used routine delivery sheaths during the procedure and then closed the ASDs by releasing a domestic occluder. Results: The closure was successful in 150 patients, and surgical repair was required in two patients. The size of the deployed occluder ranged from 10 mm to 38 mm (21.4±8.5 mm), and the procedure duration ranged from 30 to 90 min (38.2±21.4 min). No fatal complications were observed. Minor complications included transient arrhythmias (n=12) during the process of device deployment. The follow-up period was 3 months to 2 years, with no occluder dislodgment, residual fistula, or thrombus-related complications. In our comparative studies, no statistically significant differences were observed in success rates and complications. Conclusion: Transcatheter device closure of ASDs guided completely by TTE may be safe and effective and can be an alternative to traditional methods.
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Chen Q, Cao H, Zhang GC, Chen LW, Xu F. Successful totally transthoracic echocardiography guided transcatheter device closure of atrial septal defect in pregnant women. World J Clin Cases 2019; 7:734-741. [PMID: 30968038 PMCID: PMC6448076 DOI: 10.12998/wjcc.v7.i6.734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 02/14/2019] [Accepted: 02/18/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Transcatheter device closure of atrial septal defect (ASD) guided by fluoroscopy and/or transesophageal echocardiography is a mature technology. Little study has focused on whether the technology can be guided totally by transthoracic echocardiography (TTE), even in pregnant women with ASD.
AIM To evaluate the safety and efficacy of totally TTE guided transcatheter device closure of ASD in pregnant women.
METHODS Six pregnant women (gestational age 20-26 wk) with ASD underwent transcatheter device closure totally guided by TTE at our cardiac center from January 2015 to August 2017. A routine transcatheter procedure without fluoroscopy or intubation and a domestic occluder were used in this study.
RESULTS All patients had successful closure with good clinical results, and the overall immediate complete closure rate was 100%. The size of the occluder deployed ranged from 20 to 32 mm (26.7 ± 4.3 mm), the procedure time ranged from 30 to 50 min (41.7 ± 7.5 min), and the length of hospital stay was 2-3 d (mean 2.2 ± 0.4 d). There were no serious cardiovascular related complications, and transient arrhythmias occurred in one patient during the procedure. During the follow-up period (3 mo to 2 years), no occluder dislodgement, residual fistulas, or thromboses occurred. All of the patients underwent vaginal delivery between 36 and 38 wk of gestation.
CONCLUSION Totally TTE guided transcatheter device closure of ASD in pregnant women may be safe and effective.
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Affiliation(s)
- Qiang Chen
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou 350001, Fujian Province, China
| | - Hua Cao
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou 350001, Fujian Province, China
| | - Gui-Can Zhang
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou 350001, Fujian Province, China
| | - Liang-Wan Chen
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou 350001, Fujian Province, China
| | - Fan Xu
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou 350001, Fujian Province, China
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Huang Q, Lin LY, Lin XZ. Comparison of Remifentanil-Based Fast-Track and Fentanyl-Based Routine Cardiac Anesthesia for Intraoperative Device Closure of Atrial Septal Defect (ASD) in Pediatric Patients. Med Sci Monit 2019; 25:1187-1193. [PMID: 30759074 PMCID: PMC6381809 DOI: 10.12659/msm.913387] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background The aim of this study was to evaluate the effectiveness and safety of remifentanil-based fast-track anesthesia for intraoperative device closure of atrial septal defects (ASDs). Material/Methods The clinical data of 152 pediatric patients who received intraoperative device closure of ASD in our hospital from January 2015 to December 2017 were retrospectively analyzed. Patients were divided into 2 groups: group F (remifentanil-based fast-track anesthesia group, n=72) and group C (fentanyl-based routine anesthesia group, n=80). The relevant data from 2 groups were collected and analyzed. Results No significant differences were found in the preoperative data or intraoperative hemodynamic index between these 2 groups. Group C was significantly inferior to group F regarding the duration of mechanical ventilation, length of intensive care unit (ICU) stay, length of hospital stay, and hospitalization expenses (P<0.05). In terms of postoperative complications, no death, third-degree atrioventricular block, occluder detachment, or residual leakage was reported in either group. The incidence of lung infections and bronchospasm was significantly higher in group C than in group F. There were no anesthetic-related complications. Conclusions The application of remifentanil-based fast-track anesthesia for intraoperative device closure of ASD is as effective and safe as fentanyl-based routine anesthesia. Moreover, remifentanil-based fast-track anesthesia has the advantages of shorter duration of mechanical ventilation, shorter length of hospital and ICU stay, fewer postoperative complications, and lower hospitalization expenses, and is therefore worthy of promotion in clinical practice.
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Affiliation(s)
- Qing Huang
- Department of Anesthesia, The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China (mainland)
| | - Lan-Ying Lin
- Department of Anesthesia, The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China (mainland)
| | - Xian-Zhong Lin
- Department of Anesthesia, The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China (mainland)
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Early- and Long-term Outcomes of Cardiovascular Surgery via Minimal Right Vertical Infra-axillary Thoracotomy: A 15-year Study of 1,126 Patients. Sci Rep 2018. [PMID: 29531314 PMCID: PMC5847571 DOI: 10.1038/s41598-018-22824-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This study reviews our results and experience with cardiothoracic surgery via RVIAT over the past 15 years. This retrospective overview summarises our results, describing the early and late clinical outcomes of 1,126 patients, including 370 ASD closures, 488 VSD closures and 268 valve surgeries, at a single center between October 2001 and December 2015. The mean follow-up time was 52 ± 35 months (range 8–120 months). The mean incision length was 6 ± 2.22 cm (range 3.9–8.9 cm). No patient required conversion to median sternotomy. All patients were satisfied with the cosmetic results at the follow-up assessment. No chest deformity or asymmetrical development of the breast was observed. Although there was no severe morbidity and operative mortality, ten late deaths occurred, 8 of which were due to cardiac causes and the other 2 to non-cardiac causes. RVIAT offers encouraging short- and long-term patient survival results and is a safe and reproducible approach with excellent late results. RVIAT should be considered as an alternative to conventional median sternotomy.
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Cao H, Chen Q, Zhang GC, Chen LW, Qiu ZH, Lu H. Percutaneous device closure of atrial septal defect with totally transthoracic echocardiography guide, without x-ray machine. Medicine (Baltimore) 2016; 95:e5256. [PMID: 27858888 PMCID: PMC5591136 DOI: 10.1097/md.0000000000005256] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The present study investigated the feasibility of totally transthoracic echocardiography-guided percutaneous device occlusion of atrial septal defects (ASDs) without using x-ray equipment.Between September and December 2014, we performed totally transthoracic echocardiography-guided percutaneous device occlusion for 20 patients with secundum ASD without using x-ray equipment. We carried out percutaneous femoral vein puncture, used a specialized delivery sheath during operation, and closed the ASD by releasing an occluder.All 20 patients experienced successful occlusion and smoothly went through the perioperative period. The average procedure time ranged from 30 to 40 minutes (32.4 ± 3.5 minutes), and the size of the implanted occluder ranged from 20 to 38 mm (25.4 ± 5.8 mm). No occluder displacements, residual fistula, or thrombus-related complications after the procedure. There was no clinical death, no arrhythmia, no hemolysis, no infection, or embolism during patients' hospitalization and the follow-up period.Totally transthoracic echocardiography-guided percutaneous device occlusion of ASDs without the use of x-ray equipment may be safe and feasible.
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Affiliation(s)
- Hua Cao
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, P.R. China
- Correspondence: Hua Cao, Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Xinquan Road, Fuzhou, P. R. China, (e-mail: )
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An G, Zhang H, Zheng S, Wang W, Wu Q, Xing Q. Minimally invasive surgical closure for doubly committed subarterial ventricular septal defects through a right subaxillary thoracotomy. Interact Cardiovasc Thorac Surg 2016; 23:924-928. [DOI: 10.1093/icvts/ivw255] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 06/04/2016] [Accepted: 06/22/2016] [Indexed: 11/13/2022] Open
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Gil-Jaurena JM, Pérez-Caballero R, Pita-Fernández A, González-López MT, Sánchez J, De Agustín JC. How to set-up a program of minimally-invasive surgery for congenital heart defects. Transl Pediatr 2016; 5:125-133. [PMID: 27709093 PMCID: PMC5035755 DOI: 10.21037/tp.2016.06.01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Mid-line sternotomy is the commonest incision for cardiac surgery. Alternative approaches are becoming fashionable in many centres, amidst some reluctance because of learning curves and overall complexity. Our recent experience in starting a new program on minimally invasive pediatric cardiac surgery is presented. The rationale for a stepwise onset and the short-medium term results for a three-year span are displayed. METHODS A three-step schedule is planned: First, an experienced surgeon (A) starts performing simple cases. Second, new surgeons (B, C, D, E) are introduced to the minimally invasive techniques according to their own proficiency and skills. Third, the new adopters are enhanced to suggest and develop further minimally invasive approaches. Two quality markers are defined: conversion rate and complications. RESULTS In part one, surgeon A performs sub-mammary, axillary and lower mini-sternotomy approaches for simple cardiac defects. In part two, surgeons B, C, D and E are customly introduced to such incisions. In part three, new approaches such as upper mini-sternotomy, postero-lateral thoracotomy and video-assisted mini-thoracotomy are introduced after being suggested and developed by surgeons B, C and E, as well as an algorithm to match cardiac conditions and age/weight to a given alternative approach. The conversion rate is one out of 148 patients. Two major complications were recorded, none of them related to our alternative approach. Four minor complications linked to the new incision were registered. The minimally invasive to mid-line sternotomy ratio rose from 20% in the first year to 40% in the third year. CONCLUSIONS Minimally invasive pediatric cardiac surgery is becoming a common procedure worldwide. Our schedule to set up a program proves beneficial. The three-step approach has been successful in our experience, allowing a tailored training for every new surgeon and enhancing the enthusiasm in developing further strategies on their own. Recording conversion-rates and complications stands for quality standards. A twofold increase in minimally invasive procedures was observed in two years. The short-medium term results after three years are excellent.
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Affiliation(s)
- Juan-Miguel Gil-Jaurena
- Department of Pediatric Cardiac Surgery, Hospital Gregorio Marañón, Madrid, Spain; ; Department of Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Ramón Pérez-Caballero
- Department of Pediatric Cardiac Surgery, Hospital Gregorio Marañón, Madrid, Spain; ; Department of Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Ana Pita-Fernández
- Department of Pediatric Cardiac Surgery, Hospital Gregorio Marañón, Madrid, Spain; ; Department of Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - María-Teresa González-López
- Department of Pediatric Cardiac Surgery, Hospital Gregorio Marañón, Madrid, Spain; ; Department of Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Jairo Sánchez
- Department of Pediatric Cardiac Surgery, Instituto Cardiológico, Bucaramanga, Colombia
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Gil-Jaurena JM, González-López MT, Pérez-Caballero R, Pita A, Castillo R, Miró L. 15 years of minimally invasive paediatric cardiac surgery; development and trends. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.anpede.2015.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Gil-Jaurena JM, González-López MT, Pérez-Caballero R, Pita A, Castillo R, Miró L. [15 years of minimally invasive paediatric cardiac surgery; development and trends]. An Pediatr (Barc) 2015. [PMID: 26216279 DOI: 10.1016/j.anpedi.2015.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION The minimally invasive approach is seldom reported in paediatric cardiac surgery. Teams gathering experience are scarce, with programs focused on simple cases. The experience is presented on a series of over 200 cases operated on in the past 15 years. MATERIAL AND METHODS A sub-mammary approach program was started in 2000, which was gradually extended to include more complex and younger patients. The axillary incision was adopted in 2009, following the same steps. In 2013, the mini-sternotomy incision was introduced, increasing our armamentarium. From July 2000 until December 2014, 203 patients were operated on. The sub-mammary approach was used in 102 cases, axillary in 50 patients, mini-sternotomy in 44, postero-lateral thoracotomy in 4 cases, and upper mini-sternotomy in 3. RESULTS By diagnosis, ostium secundum atrial septal defect was the most common (128), followed by sinus venosus (20), ventricular septal defect (20), ostium primum (16), and others (19). One patient was converted to sternotomy. No neurological events were detected. The mean age was 7.8/3.7 and 1.8 years, and the mean weight was 28.1/16.1 and 9.4 Kg. in the sub-mammary, axillary and mini-sternotomy approaches, respectively. The aesthetic results were excellent. CONCLUSIONS Based on our 15 years of experience, minimally invasive surgery is safe and yields excellent cosmetic results. The gradual introduction of alternative approaches (sub-mammary, axillary, mini-sternotomy) allowed us to set-up guidelines and learning curves. The wide range of incisions enables the most appropriate one to be selected depending on age/weight and cardiac condition.
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Affiliation(s)
| | | | | | - Ana Pita
- Cirugía Cardiaca Infantil, Hospital Gregorio Marañón, Madrid, España
| | - Rafael Castillo
- Cirugía Cardiaca Infantil, Hospital Carlos Haya Málaga, Málaga, España
| | - Luis Miró
- Cirugía Cardiaca Infantil, Hospital Valle de Hebrón, Barcelona, España
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Martin SS, Shapiro EP, Mukherjee M. Atrial septal defects - clinical manifestations, echo assessment, and intervention. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2015; 8:93-8. [PMID: 25861226 PMCID: PMC4373719 DOI: 10.4137/cmc.s15715] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 10/29/2014] [Accepted: 11/09/2014] [Indexed: 11/21/2022]
Abstract
Atrial septal defect (ASD) is a common congenital abnormality that occurs in the form of ostium secundum, ostium primum, sinus venosus, and rarely, coronary sinus defects. Pathophysiologic consequences of ASDs typically begin in adulthood, and include arrhythmia, paradoxical embolism, cerebral abscess, pulmonary hypertension, and right ventricular failure. Two-dimensional (2D) transthoracic echocardiography with Doppler is a central aspect of the evaluation. This noninvasive imaging modality often establishes the diagnosis and provides critical information guiding intervention. A comprehensive echocardiogram includes evaluation of anatomical ASD characteristics, flow direction, associated abnormalities (eg, anomalous pulmonary veins), right ventricular anatomy and function, pulmonary pressures, and the pulmonary/systemic flow ratio. The primary indication for ASD closure is right heart volume overload, whether symptoms are present or not. ASD closure may also be reasonable in other contexts, such as paradoxical embolism. ASD type and local clinical expertise guide choice of a percutaneous versus surgical approach to ASD closure.
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Affiliation(s)
- Seth S Martin
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Edward P Shapiro
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Monica Mukherjee
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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