<strong>Background:</strong> <span style="font-family:;" "=""><span style="font-family:Verdana;">Atrial Septal Defect (ASD) closure is a common cardiac surgic...<strong>Background:</strong> <span style="font-family:;" "=""><span style="font-family:Verdana;">Atrial Septal Defect (ASD) closure is a common cardiac surgical procedure performed worldwide. Due to favourable clinical outcome, minimal invasive approach is becoming popular. Hence this study was conducted to compare the outcome of two surgical approaches, median sternotomy and mini thoracotomy with total peripheral cannulation, in a developing country Nepal.</span><b><span style="font-family:Verdana;"> Methods: </span></b><span style="font-family:Verdana;">A prospective study of 62 ASD patients, randomized to undergo surgical closure either via right anterior mini thoracotomy or median sternotomy was conducted and followed up over three years. The clinical outcome parameters like intensive care unit stay, hospital stay, post-operative duration of ventilation, cardiopulmonary bypass time, aortic cross clamp time, mediastinal drainage, size of scar and complication were compared between two groups. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">Cardiopulmonary bypass time and aortic cross clamp time were significantly longer in right anterior mini thoracotomy group as compared to median sternotomy group (43.97</span></span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">min ± 12.70</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">min vs 34.42</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">min ± 10.42</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">min and 25.13</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">min </span><span style="font-family:Verdana;">±</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">7.82</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">min vs 19.48</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">min ± 6.93</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">min respectively, p</span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">value</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;"><</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">0.05). There was no significant difference in duration of surgery (2.75</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">hrs ± 0.43</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">hrs vs 2.56</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">hrs ± 0.41</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">hrs, p-value</span><span style="font-family:Verdana;"> = </span><span style="font-family:Verdana;">0.09), post-operative ventilation (2.90</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">hrs ± 1.22</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">hrs and 2.88</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">hrs ± 1.07</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">hrs, p</span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">value</span><span style="font-family:Verdana;"> = </span><span style="font-family:Verdana;">0.96) between two groups. Post-operative mediastinal drainage was significantly less in right anterior mini thoracotomy group (214.52</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">ml ± 91.79</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">ml vs 284.03</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">ml ± 158.91</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">ml, p</span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">value</span><span style="font-family:Verdana;"> = </span><span style="font-family:;" "=""><span style="font-family:Verdana;">0.04). There was no significant difference in ICU stay and hospital stay. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Atrial septal defect can be safely closed by right anterior mini thoracotomy with a small, cosmetically acceptable submammary scar with less pain and bleeding.</span></span>展开更多
文摘<strong>Background:</strong> <span style="font-family:;" "=""><span style="font-family:Verdana;">Atrial Septal Defect (ASD) closure is a common cardiac surgical procedure performed worldwide. Due to favourable clinical outcome, minimal invasive approach is becoming popular. Hence this study was conducted to compare the outcome of two surgical approaches, median sternotomy and mini thoracotomy with total peripheral cannulation, in a developing country Nepal.</span><b><span style="font-family:Verdana;"> Methods: </span></b><span style="font-family:Verdana;">A prospective study of 62 ASD patients, randomized to undergo surgical closure either via right anterior mini thoracotomy or median sternotomy was conducted and followed up over three years. The clinical outcome parameters like intensive care unit stay, hospital stay, post-operative duration of ventilation, cardiopulmonary bypass time, aortic cross clamp time, mediastinal drainage, size of scar and complication were compared between two groups. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">Cardiopulmonary bypass time and aortic cross clamp time were significantly longer in right anterior mini thoracotomy group as compared to median sternotomy group (43.97</span></span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">min ± 12.70</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">min vs 34.42</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">min ± 10.42</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">min and 25.13</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">min </span><span style="font-family:Verdana;">±</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">7.82</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">min vs 19.48</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">min ± 6.93</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">min respectively, p</span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">value</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;"><</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">0.05). There was no significant difference in duration of surgery (2.75</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">hrs ± 0.43</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">hrs vs 2.56</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">hrs ± 0.41</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">hrs, p-value</span><span style="font-family:Verdana;"> = </span><span style="font-family:Verdana;">0.09), post-operative ventilation (2.90</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">hrs ± 1.22</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">hrs and 2.88</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">hrs ± 1.07</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">hrs, p</span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">value</span><span style="font-family:Verdana;"> = </span><span style="font-family:Verdana;">0.96) between two groups. Post-operative mediastinal drainage was significantly less in right anterior mini thoracotomy group (214.52</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">ml ± 91.79</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">ml vs 284.03</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">ml ± 158.91</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">ml, p</span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">value</span><span style="font-family:Verdana;"> = </span><span style="font-family:;" "=""><span style="font-family:Verdana;">0.04). There was no significant difference in ICU stay and hospital stay. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Atrial septal defect can be safely closed by right anterior mini thoracotomy with a small, cosmetically acceptable submammary scar with less pain and bleeding.</span></span>