Minimal Incision Partial Sternotomy ASD Repair

This video showcases a minimal incision, partial sternotomy exposure for complete ASD patch repair performed at Arkansas Children’s Hospital.

A skin incision was made at the angle of Louis and extended inferiorly, just proximal to the xiphoid process. This was then extended with electrocautery. Limited bilateral mobilization of the muscle flaps were performed, and an oscillating saw was then used to create a partial sternal split, with J’ing at the angle of louis. The assistance use of the army/navy retractor aids in the avoidance of damaging the right internal mammary artery. Patient was then placed on cardiopulmonary bypass and arrested in the standard fashion. Right atriotomy was performed and allowed for direct vision of a secundum ASD. All 4 pulmonary veins were noted to be draining normally. CorMatrix patch material was brought to the field and sized accordingly and sewn in with 5-0 prolene in a running fashion. Several large breaths were provided prior to tying the patch down for de-airing the left atrium.
Echocardiographic findings of right atrial and ventricular dilatation
Severe/refractory pulmonary HTN. Bony abnormalities. Unfavorable anatomy including partial anomalous veins or more complex intra cardiac repair requirements.
The minimally invasive incision begins at the angle of Louis and extendeds inferiorly, just proximal to the xyphoid process. Bicaval cardiopulmonary bypass which is initiated with only one cannula in, and requires IVC cannulation in order to decompress the heart. Patent was given 15ml/kg of Del Nido cardioplegia solution and kept normothermic
Transthoracic echocardiogram, Chest x-ray and PE
Important landmarks for the incision include: manubrium, xyphoid process, sternal body, and the angle of louis Moderate size high secundum atrial septal defect with left to right shunt. Left aortic arch with aberrant origin of the right subclavian artery from the proximal descending thoracic aorta. Note, this does not constitute a vascular ring.
Advantages: Correction of intra-atrial left – to- right shunt. Maintained stability of upper body by avoiding full sternotomy. Quicker time to recover from surgery. Cosmesis.
Risks include: bleeding, infection, possible av node dysfunction, need for conversion to standard full sternotomy.
Comprehensive Surgical management of Congenital Heart Disease – Richard Jonas ISBN: 978-1-4441-1215-3 Mylonas, K. S., Ziogas, I. A., Evangeliou, A., Hemmati, P., Schizas, D., Sfyridis, P. G., Economopoulos, K. P., Bakoyiannis, C., Kapelouzou, A., Tzifa, A., & Avgerinos, D. V. (2020). Minimally Invasive Surgery vs Device Closure for Atrial Septal Defects: A Systematic Review and Meta-analysis. Pediatric cardiology, 41(5), 853–861. https://doi.org/10.1007/s00246-020-02341-y Liava'a, M., & Kalfa, D. (2018). Surgical closure of atrial septal defects. Journal of thoracic disease, 10(Suppl 24), S2931–S2939. https://doi.org/10.21037/jtd.2018.07.116

Review Minimal Incision Partial Sternotomy ASD Repair.

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