[Closure of an atrial septal defect by a mini-thoracotomy with the help of extra-corporal circulation]

"Minimal invasive" surgical closure of an atrial septal defect (ASD) is performed under femoro-femoral CPB, the superior vena cava being (IVC) drained by a supplementary cannula placed directly through the thoracic opening. We present a new technique where both vena cavae are drained by a single 2 stage femoral cannula.

The cannula is introduced through the femoral vein and its distal holes are directed into the superior vena cava (SVC) while the proximal holes are maintained into the IVC. A centrifugal pump is placed on the venous line between the cannula and the venous reservoir in order to improve the venous return. Both IVC and SVC are clamped around the cannula to isolate the right atrium before opening it and repairing the ASD.

We recently operated on a 60 years old man using this technique. Passive venous drainage was 2.6 l/min whereas the perfusion theoretical flow was 5.4 l/min. But adding the centrifugal pump increased the flow to 5.4 l/min which ensured an optimal perfusion flow. CPB time was 38 minutes and operative time was 140 minutes. There were no complications and the patient returned home at day 5 following the operation.

Using a single venous cannula for drainage of both vena cavae simplifies the technique and therefore contributes to the development of "minimally invasive" cardiac surgery.