Minimally invasive video-assisted surgical closure of atrial septal defects: a safe approach

To compare the safety and effectiveness of video-assisted thoracic surgery (VATS) versus conventional median sternotomy (open) in the repair of secundum atrial septal defect (ASD) or patent foramen ovale (PFO).

Among 415 consecutive patients undergoing open or VATS ASD/PFO closure between 1993 and October 2012, 153 patients were compared using 2:1 frequency matching (n=102 open vs 51 VATS). Matching variables include age, gender, body surface area, past medical history of neurologic events, and need of patch closure. Median age was 43 years (3-71 years), and 67% were female.

There were no early deaths in either group. There were no conversions to open sternotomy. Although mean cross-clamp time (14.5±7.6 vs 26.3±13.2 minutes, P<.001) and bypass time (31.7±13.8 vs 60.9±20.9 minutes, P<.001) were longer in the VATS group, patients who underwent VATS had shorter postoperative ventilation time (7.5±6.4 vs 4.4±2.8 hours, P=.03) with 62.7% extubated in the operating room, along with shorter intensive care unit stay (26.7±10.8 vs 19.1±9.9 hours, P<.001) and hospital stay (5.2±1.9 vs 3.5±0.9 days, P<.001). At early follow-up (mean 1.5 years, maximum 4.2 years), there was no difference in need for reintervention. Of the 27 patients who underwent VATS ASD/PFO closure for a neurologic event, none had a recurrence.

The use of VATS provides a safe, equally effective alternative to conventional sternotomy for ASD/PFO closure, using a less invasive approach.