Atrial septal defect (ASD) is one of the most common congenital lesions in adults. Percutaneous device closure remains the preferred approach. For ASDs that are not amenable to percutaneous closure, minimally invasive ASD repair represents an important and safe alternative.
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Nguyen TC. Minimally Invasive ASD Repair: Step-by-Step Guide. February 2018. doi:10.25373/ctsnet.5904877.
3 Comments
What about cardioplegia? What way did you use? And aortic clamp placement?
Thanks
Thank you Dr. Carlos Troconis. I use Del Nido Cardioplegia (1:4 ratio) and am comfortable going up to 90 minutes without redosing. Almost all adult patients will get 1000cc. We can probably get away with longer. If at 50 minutes I feel I can finish within the next 20 minutes, then I do not redose. If at 50 minutes I feel like I need MORE than 20 minutes, I will usually give an additional 200-300cc and this will buy me an additional 45 minutes or so. There’s obviously not a lot of data or science behind this and you’ll get different responses but this has worked for me. For cross-clamp, I use a flexible Navarro cross clamp through the incision. An alternative is Chitwood through a separate incision or endoballoon. Hope that helps.
Thank you for this video, Dr. Nguyen. What is your opinion about using induced ventricular fibrillation instead of aortic cross-clamping and cardioplegia? Have you ever used right midaxillary thoracotomy with transthoracic aortic and venous cannulas placement in your practice? Thank you!