Three-port totally endoscopic repair vs conventional median sternotomy for atrial septal defect

Purposes: We assessed the validity of three-port totally endoscopic repair (3PTER) for atrial septal defect (ASD). Methods: Between February, 2000 and November, 2017, 151 patients underwent surgery for ASD. Forty-seven patients underwent 3PTER as minimally invasive cardiac surgery (MICS) and 104 patients underwent conventional median sternotomy (CMS). Propensity matching yielded 94 matched patients (47 vs 47). We compared the early results between the groups. The 3PTER technique was performed with the patient in the partial left lateral position, under cardio-pulmonary bypass (CPB) established through a groin incision. The three ports consisted of a main incision (3 cm), a trocar for the left-handed instrument, and a camera port in right antero-lateral chest. Results: MICS needed longer cross clamp and CPB times (57, 48–86 vs 24, 16–30 min, p < 0.01 and 115, 106–131 vs 53, 43–80 min, p < 0.01, respectively)*, although the operation time and hospital stay were significantly shorter (180, 159–203 vs 190, 161–225 min, p = 0.024 and 6.0, 6–8 vs 15, 13–19 days, p < 0.01, respectively)*. The intra-operative and postoperative bleeding were significantly less in MICS than CMS (20, 5–40 vs 225, 130–287.5 p < 0.01 and 200, 145–290 vs 340, 250–535 ml, p < 0.01, respectively)*. *: median, 25th–75th percentile. Conclusion: Irrespective of the longer CPB and cross-clamp time than for CMS, MICS had a shorter operation time, less bleeding, and resulted in quicker recovery. The 3PTER was safe and cosmetically excellent.