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

Objectives: 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. Methods: We included 538 patients who underwent surgical ostium secundum atrial septal defects closure with minimally invasive approaches. Results: 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). Conclusions: 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.