Transxiphoid approach without median sternotomy for the repair of atrial septal defects

Background. Interest in minimally invasive procedures has recently increased because it results in less surgical trauma, decreased patient discomfort, short hospital stay, reduced costs, and better cosmetic appearance. Based on these facts, we have been using the transxiphoid process approach without sternotomy for the correction of atrial septal defects. Methods. From July 1996 to January 1997, the xiphoid process window approach was performed in 10 patients with ostium secundum atrial septal defect. Ages ranged from 6 months to 14 years (mean, 5.3 years). In all patients, extracorporeal circulation was carried out by means of cannulation of the femoral artery and both caval veins and of aortic cross-cramping. Videothoracoscopy was used to improve visualization of the aorta. Results. There were no intraoperative or postoperative complications, and in all but 1 patient, extubation was possible while in the operating room. Conclusions. The xiphoid process window, with no median sternotomy, permitted closure of the atrial septal defects with good results and could be used as a less invasive technique for their correction. (C) 1998 by The Society of Thoracic Surgeons.