Minimally Invasive Atrial Septal Defect (ASD) ClosureUnderstanding minimally invasive surgery is important. Making the right decisions could change your life.
Minimally Invasive Atrial Septal Defect Closure
Minimally invasive ASD Closure or MICS ASD Closure often referred to as Key Hole ASD closure is a technique thats been performed since 1996 in several centers across the world. In the last decade this technique has become the standard technique of closing atrial septal defects in all advanced cardiac centers. One of the most important reasons for the technique to become popular is near zero risk in this technique as with open cases. MICS ASD as of now has been performed close to two decades and has an excellent track record of safety. Several scientific publications have now been published demonstrating that outcomes as well as safety is equal to conventional open heart techniques. When performed by trained surgeons who regularly perform minimally invasive procedures, the outcome is definitely superior to the conventional technique.
Technique of Minimally Invasive ASD Closure
The procedure is done through a small 2.5cm cut either below the right breast or near the arm pit. No bones are cut. The ribs immediately below the cut are spread using a soft tissue retractor. The patients heart is stopped using the support of cardiopulmonary bypass. The right sided chamber is opened. An endoscope or videoscope is then introduced to identify the defect. Under visual guidance the defect in the heart is closed using direct suturing technique with or without a patch. The closure usually takes less than 10 minutes to do. The entire procedure lasts less than an hour.
Reduction in Pain
Reduced Use of Narcotic Analgesia
Days In Hospital
Days to Recover
Key Hole or Open ASD closure? What should I choose?
Key Hole Technique
This is now the popular and standard approach. In this approach, no bones are cut. A small cut is made just below the breast or near the armpit on the right side. A video camera is introduced and under vision the hole is closed using sutures. A patch of the patients own pericardium is used to close the hole if the defect is very large. All kinds of defects ranging from the simple secundum ASD to the more complex Sinus Venous ASD where rerouting is required can be done by this technique. Once closed, the treatment is permanent. Normal activity can be resumed almost immediately. The advantage of this approach is that none of the bones are cut, significantly reducing pain. It allows for much faster healing. The cut is a mere 4cms. Skin infection is near zero and as no bone is cut the dreaded bone infection (Osteomyelitis) is eliminated. Not cutting the bone also decreases blood loss during the operation and this in turn translates into significantly reduced need for blood transfusion.
Sternotomy Approach (Conventional)
In this conventional but old technique the breast bone or sternum is cut open to reach the heart. The atrial septal defect is approached by opening the right atrium after establishing cardiopulmonary bypass and arresting the heart. The defect may be closed directly or with the patients own pericardium depending not the size of the defect. Fine sutures are used to sew. These sutures are permanent and are inert. Once the defect is closed the patient is weaned off the heart lung machine while the heart resumes its normal activity. aortic valve is approached between the ribs on the right side. Usually the space between the second and third rib is the site of entry. The biggest disadvantage of the technique is that this simple operation involves cutting open the breast bone or sternum and all it’s attendant complications. In current practice this operation has no role unless complicated by other coexistent conditions.
Reduction in Wound Infection
Reduced Blood Transfusion
Total MICS Operations
- Success Rates 99% 99%
Having initiated the program in 2008 the surgical group headed by Dr Nambala at Apollo, Bangalore has performed more than 2000 Minimally Invasive operations (MICS). The outcomes have been exceptionally good and match the best hospitals in the world. We are one among a handful of centers in the country who can perform these operations without cutting the bone. We take great pride in our outcomes and we routinely conduct training programs, observerships and live workshops at other centers with the aim of training surgeons across the country. Till date we have performed live surgeries at almost all leading heart centers in the country and our series is the largest in the country.