Effects Of Minimally Invasive Treatment For Atrial Septal Defect

Objective :To explore the safety and feasibility of minimally invasive treatment system for secondary atrial septal defect.Method :Clinical data of patients with secondary atrial septal defect who underwent surgical treatment in the Department of Cardiovascular Surgery,the Second Norman Bethune Hospital of Jilin University from January 1st,2012 to July 1st,2022 were collected.According to different surgical treatment methods,patients were divided into the following five groups: transthoracic occlusion group,trans-jugular occlusion group,right mini-thoracotomy group,right axillary mini-thoracotomy group and thoracoscopic group.Gender,age and weight of patients were retrospectively analyzed.Clinical data such as operation time,extracorporeal circulation time,blood transfusion,tracheal intubation time,ICU stay time,postoperative complications,hospitalization time and hospitalization cost were analyzed.Result :All the patients achieved good operation results,and no death case occurred.No serious complications such as low cardiac output syndrome,ventricular fibrillation,degree II or above atrioventricular block,liver and kidney injury or failure,and occluder abscission were found.There were 34 patients in the thoracic occlusion group,including 21(61.7%)female patients,age 32.47 ± 18.50 years old,maximum defect diameter 14.64 ± 5.59 mm,closure device 21.87 ± 6.51 mm,operation time75.38 ± 49.04 minutes,the success rate of operation was 100%.There were no surgical complications.There were a total of 98 patients in the trans-jugular occlusion group,including 72(73.4%)female patients,aged 36.76 ± 18.69 years old.The maximum defect diameter was 15.36 ± 5.62 mm,the closure device was 21.79 ±5.63 mm,and the operation time was 38.01 ± 21.62 minutes.The operation success rate was 94.2%.Postoperative complications occurred in 4 cases(4.1%).There were a total of 98 patients in the right mini-thoracotomy group,including 73(74.5%)female patients,aged 35.92 ± 11.79 years old,maximum defect diameter 26.06 ± 8.89 mm,operation time 172.76 ± 51.90 minutes,13(13.3%)patients with blood transfusion.52(53.1%)combined with other surgical procedures.Postoperative complications occurred in 3(3%)cases.A total of 10 patients in the right axillary mini-thoracotomy group were female,including 6(60%)patients,aged 7.50 ± 3.47 years,maximum defect diameter 19.22 ± 10.07 mm,operation time 158.70 ± 28.20 minutes,3(30%)patients with blood transfusion.The success rate of surgery was 100%,and no operation-related complications occurred.A total of 66 patients were enrolled in the thoracoscopic group,including 45(68.2%)females,aged 34.79 ± 13.13 years old,maximum defect diameter 25.09 ± 9.75 mm,operation time 218.39 ± 125.84 minutes,and 6(9.1%)patients with blood transfusion,with a success rate of 100%.Among them,36(54.5%)patients were combined with other surgical procedures,and 4(6%)patients had postoperative complications.Conclusion:1.Minimally invasive treatment of ASD has definite surgical effects,with advantages of less trauma and faster recovery.2.According to the patients’ conditions and ASD anatomical characteristics,appropriate minimally invasive surgical methods can be selected individually.3.Various minimally invasive treatments complement each other and jointly participate in the construction of minimally invasive treatment system for secondary perforated atrial septal defect.