Septum secundum

Interquartile range

Internal medicine

Surgery

Cardiology

Intensive care unit

Minimally invasive cardiac surgery

Patent foramen ovale

Cardiac surgery

Cardiopulmonary bypass

Ostium

Atrial fibrillation

Percutaneous

Foramen secundum

Medicine

Interactive Cardiovascular and Thoracic Surgery

Our goal was to evaluate the results of our 20-year experience with minimally invasive surgical approaches for closing ostium secundum atrial septal defects, focusing on clinical results, patient satisfaction and cost-effectiveness. We included 538 patients who underwent surgical ostium secundum atrial septal defects closure with minimally invasive approaches. The minimally invasive approaches included right anterior minithoracotomy (n = 335, 62%), midline lower ministernotomy (135, 25%) and right lateral minithoracotomy (n = 68, 13%). Central cannulation was used in 374 patients (69%), whereas, more recently, a remote cardiopulmonary bypass with peripheral cannulation was used in 164 selected patients (31%). Median intensive care unit and postoperative hospitalization stays were 1 day [interquartile range (IQR) 1–1 day] and 5 days (IQR 5–6 days), respectively. Thirty-one patients had postoperative complications (5.8%); postcardiotomy syndrome was the most frequent complication (n = 20/538, 3.7%). Decreases in the length of postoperative hospitalization (P < 0.001) and in hospital costs (P = 0.009) were achieved over time. At a median follow-up of 12.1 years (IQR 0.6–14 years), all patients are in good clinical condition with no limitations to physical activity. The vast majority of patients (524/538 patients, 97%) were very satisfied with the result of the minimally invasive approaches (99/100 patients, 99% in the last 5 years). Minimally invasive approaches for closing ostium secundum atrial septal defects proved safe and effective both in children and in adults with a very high satisfaction rate for the cosmetic result. A continuous evolution of our minimally invasive approaches, with a constant quest for less invasive procedures, led us to a miniaturization of the surgical accesses, reducing hospitalization time and hospital costs.

Minimally invasive surgery for atrial septal defects: a 20-year experience at a single centre