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ARTICLE

Comparative Clinical Outcomes of Right Lateral Thoracotomy and Totally Thoracoscopic Surgery for Adult Patients with Atrial Septal Defect: A Single Center, Retrospective Study

Yushen Fang¹, Zechen Li¹, Jiahong Li¹, Kaiyu Wang¹, Gang Xu¹, Shusheng Wen^1,2, Jimei Chen^1,2, Jian Zhuang^1,2, Haiyun Yuan^1,2,*, Xiaobing Liu^1,2,*

1 Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
2 Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou, 510080, China

* Corresponding Authors: Haiyun Yuan. Email: ; Xiaobing Liu. Email:

(This article belongs to the Special Issue: Novel Methods and Techniques for the Management of Congenital Heart Disease)

Congenital Heart Disease 2025, 20(3), 357-368. https://doi.org/10.32604/chd.2025.066817

Received 18 April 2025; Accepted 25 June 2025; Issue published 11 July 2025

Abstract

Background: Totally thoracoscopic surgery (TTS) and right lateral thoracotomy (RLT) are both extensively utilized in the surgical repair for atrial septal defect (ASD). However, RLT is generally considered in low-weight pediatric patients as a result of restricted surgical exposure. This study aims to introduce an RLT approach for ASD repair in adults and compare its clinical outcomes with TTS. Methods: We conducted a retrospective analysis of the clinical data of 23 adult patients who underwent ASD repair at Guangdong Provincial People’s Hospital between June and October 2024. Patients were divided into two groups based on the surgical approach they adopted: group totally thoracoscopic surgery (TTS, n = 12) and group right lateral thoracotomy (RLT, n = 11). All individuals finished a follow-up three months after surgery. Operative parameters, postoperative courses, echocardiographic measurements and laboratory investigations were compared between the two groups. Results: The total surgical duration was significantly longer in group RLT compared with group TTS [(234.00 ± 47.93) min vs. (175.17 ± 52.36) min, p = 0.011]. Group RLT exhibited a significantly higher respiratory index (RI) at <6 h postoperatively (1.00 ± 0.58 vs. 0.30 ± 0.37, p = 0.01) and significantly lower levels of soluble suppression of tumorigenicity 2 (sST2) [(136.61 ± 43.12) ng/mL vs. (199.08 ± 33.56) ng/mL, p = 0.037] and cardiac troponin (cTnT) [(277.04 ± 89.85) pg/mL vs. (343.30 ± 482.40) pg/mL, p = 0.047] at 12–24 h postoperatively. Echocardiographic measurements showed no significant differences between two groups, except for a more pronounced reduction in left atrial (LA) size at discharge in group TTS [(5.00 ± 3.64) mm vs. (0.09 ± 4.44) mm, p = 0.008]. Conversely, group RLT demonstrated a less significant decrease in glutamyl transpeptidase (GGT) [(1.00 ± 6.00) U/L vs. (5.25 ± 3.86) U/L, p = 0.026] but a more significant decrease in blood urea nitrogen (BUN) [(1.81 ± 1.10) mg/dL vs. (0.81 ± 1.07) mg/dL, p = 0.038]. Conclusions: RLT for ASD repair in adults demonstrated comparable clinical outcomes to TTS in terms of postoperative recovery and cardiac function and also produced fewer scars than TTS. Our study proved the feasibility, safety and cosmetic effects of uniport RLT for ASD repair in adults when compared with TTS.

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