TY  - EJOU
AU  - Fang, Yushen 
AU  - Li, Zechen 
AU  - Li, Jiahong 
AU  - Wang, Kaiyu 
AU  - Xu, Gang 
AU  - Wen, Shusheng 
AU  - Chen, Jimei 
AU  - Zhuang, Jian 
AU  - Yuan, Haiyun 
AU  - Liu, Xiaobing 

TI  - Comparative Clinical Outcomes of Right Lateral Thoracotomy and Totally Thoracoscopic Surgery for Adult Patients with Atrial Septal Defect: A Single Center, Retrospective Study
T2  - Structural and Congenital Heart Disease

PY  - 2025
VL  - 20
IS  - 3
SN  - 3071-1738

AB  - <b>Background:</b> 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. <b>Methods:</b> 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. <b>Results:</b> 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, <i>p</i> = 0.011]. Group RLT exhibited a significantly higher respiratory index (RI) at <6 h postoperatively (1.00 ± 0.58 vs. 0.30 ± 0.37, <i>p</i> = 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, <i>p</i> = 0.037] and cardiac troponin (cTnT) [(277.04 ± 89.85) pg/mL vs. (343.30 ± 482.40) pg/mL, <i>p</i> = 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, <i>p</i> = 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, <i>p</i> = 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, <i>p</i> = 0.038]. <b>Conclusions:</b> 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.
KW  - Atrial septal defect; right lateral thoracotomy; totally thoracoscopic surgery; adult patient; clinical outcome

DO  - 10.32604/chd.2025.066817