Background:Over the years, surgeons have used a midline sternotomy to repair atrial septal defects (ASD) with good long-term outcomes but unsatisfactory cosmosis.Because of this, less intrusive surgical procedures are employed to lessen surgical trauma and improve the final cosmetic outcome.

Objective: to assess ASDs repair using right-anterolateral minithoracotomy (RALT) versus median sternotomy in terms of surgical outcomes.

Patients and methods: Our study was prospective, comparative, non randomized ,non blinded study that carried out at our institution between June 2016 and October 2018. It included forty surgical candidates who had isolated ostium secondum ASDs; patients were allocated to either group I (RALT group) (n=20),or group II (conventional sternotomy) (n=20).

Results: before surgeries, demographic and echocardiographic data were comparable in both groups except for more female patients(80%) in group I(p-value=0.022) and more patients with low body surface area in group II(p-value=0.002).Group II had considerably shorter total bypass time than group I(p-value=0.004).After surgeries, data were identical in both groups regarding ICU and total hospital stay, chest tube drainage,and amount of blood transfusion.However,group I had significantly shorter mechanical ventilation time(p-value=0.002) and smaller length of wound (p <0.001).Wound infection rate was substantially higher in sternotomy group(p-value=0.035).Patient satisfaction was higher in minithoracotomy group(90%) than in sternotomy group(60%).No cases required conversion to sternotomy in group I. Neither residual defects nor mortality were encountered in both groups.

Conclusion: Right anterolateral minithoracotomy approach is safe,effective,cosmotic, less traumatic, and saving resources.