Comparative Study On Treatment Of Large Secundum Atrial Septal Defects By Minimally Invasive Occlusion And By Traditional Surgery

ObjectiveThe off-pump transthoracic minimally invasive cardiac surgery with extracorporeal circulation assisted open heart surgery for treatment of large secundum atrial septal defect(atrial septal defect, ASD). The mode of operation were analyzed retrospectively, to investigate the off-pump transthoracic minimally invasive transcatheter closure of large secundum atrial septal defect for its superiority and the value of clinical application, summarize clinical experience and to assist in the selection of therapy for patients with reasonable ASD. MethodsA total of 78 patients with large secendum ASD were collected from April 1, 2013 to September 30, 2014 at the cardivascular sugery department of the hospital. The patients were divided into two groups, with 35 patients who had ASD repair with minimally invasive transthoracic ASD occlusion(mini invasive group), and 43 patients who underwent surgical repair under cardiopulmonary bypass(surgical operation group). The patients age ranged from 6~55 years old and atrial septal defect diameter ranged between 20~38mm. On two groups, the success rate of the operation, postoperative complications, hospitalization expenses, the number of blood transfusion, operation time, postoperative hospital stay and the rate of platelet aggregation and other aspects were comparatively analysed, in order to determine the safety and superiority of the new technology of minimally invasive transthoracic ASD closure. Results1. In the minimally invasive closure group, there was one failure as compared to the operations under cardiopulmonary bypass, operation success rate of 97.1%; surgical operation group were all successful operation, operation success rate of two groups were similar, no statistical difference(P>0.05).2. In the minimally invasive closure group, the postoperative complications occurred in 7 patients while in the surgical operation group, postoperative complications occurred in 18 patients, two groups of postoperative complication rate compared with statistical difference(P<0.05), the surgical operation group total complication rate after surgey was significantly higher than that of mini invasive group.3. In operation time, postoperative hospital stay, postoperative blood transfusion number index comparison, mini invasive group was significantly better than the surgical operation group, the difference was statistically significant(P<0.05).4. The cost of hospitalization, platelet aggregation rate results compared also have obvious differences. In the mini invasive group, platelet aggregation rate increased significantly, and the hospitalization expenses in the mini invasive group is higher than that of surgical operation group. Conclusion1. Minimally invasive transthoracic occlusion of extracorporeal circulation and assisted traditional surgical repair are effective methods to treat large secundum atrial septal defect.2. Transthoracic minimally invasive transcatheter closure of large secundum atrial septal defect compared with the traditional surgical operation has less trauma, faster recovery, less complications and other advantages and is worthy of clinical popularization and application. As surgical indications of large secundum atrial septal defect patients can first choose minimally invasive transthoracic occlusion.3. Minimally invasive transthoracic occlusion requires strict anticoagulation therapy after percutaneuos closure as minimally invasive surgical techniques is new. The short-term effect is good but there is lack of long-term follow-up, and should therefore be carried out strictly in order to determine the long-term follow-up of the safety and efficacy of this technique.