Comparative Study of Surgical Complications in Atrial Septal Defect Repair: Right Anterior Mini-thoracotomy Versus Classic Midline Sternotomy

Abstract

Background: Atrial septal defect (ASD) repair is traditionally performed via median sternotomy. With recent advances in surgery, right anterior mini-thoracotomy (RAMT) has facilitated this surgery through smaller incisions. Objectives: The present study compared the complications and outcomes of RAMT and classic midline sternotomy for ASD repair. Methods: Between July 2020 and December 2023, 70 patients who underwent ASD repair through RAMT (20 cases) or median sternotomy (50 cases) at Imam Ali Hospital affiliated with Kermanshah University of Medical Sciences and Faruk Medical City Hospital in Sulaymaniyah, Kurdistan region were retrospectively analyzed. Inclusion criteria were patients diagnosed with ASD (with or without tricuspid valve insufficiency), no significant mitral insufficiency, and pulmonary pressures < 6 mmHg. Exclusion criteria included severe pulmonary hypertension (pulmonary pressure ≥ 6 mmHg), significant mitral insufficiency, and patients with major comorbidities such as uncontrolled diabetes, severe COPD, or renal failure. Surgical approach selection was based on patient characteristics, defect size, and surgeon expertise. Pre-, intra-, and post-operative patient data were recorded. All statistical analyses were performed using SPSS software (version 23.0, IBM Corp, Armonk, NY, USA). A P-value of < 0.05 was considered statistically significant. Results: Seventy participants were included in the study. Of these, 44 were women (63%) and 26 were men (37.1%). The average age of these individuals was 37.46 ± 14.50 years. The results showed significant differences between the variables of the study, specifically in the amount of drainage after surgery (P = 0.011), the length of the incision in centimeters (P < 0.001), the length of surgery (P < 0.001), and stay in the intensive care unit (ICU) (P = 0.006) between the two surgical methods. Conclusions: The RAMT should be considered a favorable alternative to sternotomy with satisfactory results in terms of operation time, length of ICU stay, amount of drainage, and the length of the incision in centimeters, which represent lower costs and greater benefits for patients.