Comparison Between Minimal Invasive Incision and Standard Median Sternotomy for Repair of Atrial Septal Defects

Abstract

Background: Atrial septal defect (ASD) repair is traditionally performed through standard median sternotomy (SMS), but minimally invasive cardiac surgery (MICS), particularly the right vertical infra-axillary incision (RVIAI), has gained popularity due to its cosmetic and recovery advantages. Objective: To compare intraoperative, postoperative, and early outcomes of ASD repair between MICS (RVIAI) and SMS. Methods: A quasi-experimental study was conducted at Bangabandhu Sheikh Mujib Medical University from May 2023 to April 2024. Seventy-six patients were enrolled through purposive sampling, with 38 undergoing MICS and 38 SMS. Data on operative parameters, postoperative recovery, and complications were analyzed using SPSS v26. Results: Baseline characteristics were similar between groups. The MICS group had a significantly shorter incision length (3.98±0.47 cm vs. 6.63±0.78 cm; p<0.001) but longer cardiopulmonary bypass time (117.26±39.20 vs. 101.92±48.40 min; p=0.026) and total operative time (284±52.82 vs. 243.78±102.91 min; p=0.008). Postoperative pain scores were significantly lower in MICS (VAS 2.68±1.04 vs. 4.60±1.42; p<0.001). Analgesic and inotrope requirements were also significantly reduced (p<0.001 and p=0.009, respectively). No significant differences were observed in ventilation duration, ICU stay, hospital stay, transfusion needs, or postoperative complications. No mortality or residual shunt occurred in either group. Conclusion: Minimally invasive RVIAI is a safe and effective alternative to SMS for ASD repair. Despite slightly longer operative times, it offers superior cosmetic results, reduced postoperative pain, and decreased analgesic and inotrope use, with comparable clinical outcomes.