Atrial Septal Defect (ASD) is a congenital hole in the wall between the atrial chambers of the heart. It is usually detected incidentally during routine check-ups. Since this condition often comes as a surprise to the patient, the method of closing the hole becomes an important concern. The decision on how to close the hole depends on its size and location. Interventional methods can be used to close these intracardiac holes in some patients. However, the hole must not be large, it must not be close to the aorta, and the patient must not have a nickel allergy. Therefore, not every hole can be closed using the angiography method through the groin, necessitating surgical intervention. In surgical methods, minimal invasive treatment is becoming more common. This involves making 3-4 cm incisions under the right breast (referred to as the armpit by patients), which leaves no visible scar, especially in women.
Minimally invasive cardiac surgery, also known as small incision or armpit heart surgery, has become widespread since 1995. Compared to traditional heart surgeries performed through the middle of the chest, this method results in less bleeding, less need for blood transfusions, fewer infections, less pain, less use of painkillers, shorter hospital stays, and better cosmetic results. However, complications related to vascular access, such as arterial tear or venous thrombosis, have been reported due to the procedure of entering the vessels through the groin to connect the patient to the heart-lung machine.
In minimally invasive ASD closure, the procedure can be performed through a mini-thoracotomy (i.e., under the armpit) with an incision under the right breast or with the aid of a robot. In both methods, the heart-lung machine is connected through a 2 cm incision in the groin artery and vein, and the heart is stopped. In mini-thoracotomy, a 4-5 cm incision is made under the right breast (armpit) without cutting any bones, only spreading the ribs to reach the right atrium of the heart. Depending on the size of the defect, the ASD is closed either by direct stitching or by using a patch prepared from the heart’s membrane. The surgery duration is quite short, and patients recover quickly and are discharged soon.
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Frequently Asked Questions
Heart surgeries performed using armpit or minimally invasive techniques are as reliable as traditional methods and carry even less risk. These procedures are particularly safe in the hands of experienced surgeons who have extensive practice in minimally invasive surgery and have conducted scientific research, presented their findings nationally and internationally, and documented their patient outcomes. One significant advantage of this approach is that it does not involve cutting any ribs or muscles, making it less risky than other methods.
In traditional heart valve surgeries, a large incision is made by cutting through the sternum, which increases the risk of infection and necessitates prolonged chest protection post-surgery. Patients must be careful to protect their chest from impacts even after discharge. However, with the 4-5 cm incision used in minimally invasive surgery through the armpit, the patient cannot even see the surgical site. This technique significantly reduces the risk and recovery time associated with traditional surgeries.
Heart surgeries performed through the armpit, known as minimally invasive surgeries, are carried out with small incisions that vary depending on the specific condition being treated. For example, heart valve surgeries are performed through minimal incisions under the right armpit, while coronary bypass surgeries may involve small 7-8 cm incisions under the breast for single-vessel bypass. In cases where two vessels are involved, a similar incision can be made under the left armpit.
In armpit heart surgeries, no bones or muscles are cut. The heart is accessed between the ribs, allowing the necessary interventions to be performed before concluding the surgery. This approach minimizes trauma to the body, reduces recovery time, and results in less postoperative pain and scarring compared to traditional methods.
Armpit heart surgery can typically be performed on both young and elderly patients. However, it may not be suitable for individuals with advanced lung disease. Additionally, armpit heart surgery is not feasible in cases requiring triple coronary bypass, the replacement of three or more vessels, or when coronary bypass surgery needs to be combined with heart valve surgery. In such complex scenarios, traditional surgical approaches are usually preferred.