The comparision of Right anterolateral thoracotomy and Median sternotomy in the Atrial Septal Defect repair

Kim, Hyuck; Kim, Sang Heon; Kim, Young Hak; Chung, Won Sang; Kang, Jung Ho; Lee, Chul Beom; Jee, Heng Ok; Kim, Nam Soo; Kim, Kyung Soo

Abstract

BACKGROUND: Currently, atrial septal defect repair has been considered low risk operation due to the development of open heart surgery. Not only the operation itself, but also the cosmetic aspect is now focused. Though many methods exist as minimally invasive cardiac surgery in atrial septal defect repair, some surgeons advocate that right anterolateral thoracotomy is better than the others in the cosmetic aspect and we compared right anterolateral thoracotomy with median sternotomy. MATERIAL AND METHOD: From January 1999 to August 2002, 43 patient underwent atrial septal defect repair by one operator, including 15 patients through right anterolateral thoracotomy(group A) and 15 patients through median sternotomy (group B) in Hanyang university Hospital. The data were randomized and operation outcomes were analyzed between these two groups. RESULT: The mean weight of group A was 38.77+/-15.57kg and 38.21+/-21.82kg in group B. In group A, mean operation(OP) time was 197.6+/-61.40min, mean cardiopulmonary bypass(CPB) time was 48.66+/-13.02min and mean fibrillation time or aortic cross clamp (ACC) time was 30+/-11.64min. In group B, mean OP time was 212.33+/-31.95min, mean CPB time was 55+/-12.10min, and mean fibrillation or ACC time was 29.33+/-9.04min. There was no significant differences in these two groups. In group A, mean mechanical ventilation time was 3.78+/-0.78 hours, mean postoperative ICU stay was 1.2+/-0.47 days and mean postoperative hospital stay was 10.20+/-1.08 days. In group B, mean mechanical ventilation time was 5.95+/-3.73 hours, mean post operative ICU stay was 1.41+/-0.61 days, and mean postoperative hospital stay was 12.20+/-3.55 days. There was no any significant difference in two groups. Group A had significantly lower mean thoracic and pleuropericardial drainage than group B (175.33+/-90.54cc vs 352.33+/-239.43cc, p<0.05). Complication was seen in one case in group B, transient 2nd degree A-V block.
CONCLUSION
Right anterolateral thoracotomy was better than median sternotomy not only in cosmetic aspect but also in postoperative thoracic and pleuropericardial drainage, using the same instrument (p<0.05). But, right anterolateral thoracotomy was more technically difficult due to narrow operative field and we should be careful of aortic cannulation.