Lateral atrial septal defect closure with induced ventricular fibrillation versus cardioplegic arrest.

ABSTRACT

Minimally invasive surgical closure of atrial septal defects is gaining widespread acceptance and can be performed via a right midaxillary thoracotomy. In addition, the procedure can be performed in ischaemic cardiac arrest or fibrillation with a core body temperature between 34°C and 36°C. OBJECTIVES: We present our single-centre results of paediatric patients who underwent surgical atrial septal defect II closure via lateral thoracotomy. METHODS: Retrospective analysis. Patients were divided into a cardiac arrest group and a cardiac fibrillation group. All procedures were performed via right midaxillary thoracotomy through a single incision without side ports. RESULTS: All 37 consecutive patients between March 2019 and August 2022 (median age 3 years; percentile 25th 2; 75th 5 years) in both groups were free of mortality and postoperative morbidity such as haemodynamically relevant residual shunt or malignant arrhythmias. Cardiopulmonary bypass time was significantly shorter in the fibrillation group (mean 34.7 min vs 52.6 min, P = 0.01), and all patients were weaned off the ventilator immediately postoperatively. Length of the intensive care unit stay was not different between the 2 groups. Postoperative hospital stay was significantly longer in patients with cardiac arrest (mean 5.6 days vs 4.9 days, P = 0.04). Postoperative laboratory parameters did not differ between the 2 groups. All patients were discharged with normal left ventricular function and normalized cardiac enzymes. CONCLUSIONS: Minimally invasive closure of an atrial septal defect during atrial fibrillation is a safe procedure with results comparable to those of an induced cardiac arrest procedure.