A Systematic Review of Minimally Invasive Approaches to Surgical Atrial Septal Defect Repair

Abstract

AIM: Atrial septal defects (ASD) are the most common congenital cardiac malformations. Over the preceding decades, a host of minimally invasive and interventional techniques for ASD closure have emerged. Minimally invasive ASD (MIASD) repair utilises thoracotomies, endoscopic, robotic, and even beating heart approaches to facilitate MIASD repair. We performed a systematic review to summarise the literature describing the outcomes of patients following MIASD repair. METHOD: PubMed, Medline, and Scopus were searched by two authors for manuscripts describing outcomes following MIASD repair. Overall, 1,972 titles were screened, 1,945 were excluded, and 27 were included in the review. The primary outcome was mortality and secondary outcomes included postoperative morbidity. RESULTS: Measures of mortality were largely limited to 30 days postoperatively, with 0% mortality reported for MIASD up to 30 days. Rates of postoperative morbidity were low in both sternotomy and MIASD groups, with no consistent differences identified. Rates of intensive care unit and hospital stay were consistently reported to be lower with MIASD than with the conventional approach. CONCLUSIONS: MIASD repairs have continued to evolve and improve. Among the various approaches to MIASD repair, all have been associated with low rates of morbidity and mortality. Surgical ASD repair continues to be versatile, allowing for repair of all manner of ASDs, and allowing for the concomitant management of other cardiac conditions. Regular advancements in this field, including the optimisation and development of surgical techniques with regular evaluation of patient outcomes, will ensure appropriate patient selection and optimisation of outcomes for patients with ASD.