Original article
Cardiovascular
Minimally Invasive Congenital Cardiac Surgery Through Right Anterior Minithoracotomy Approach

https://doi.org/10.1016/j.athoracsur.2007.11.068Get rights and content

Background

Median sternotomy has been the conventional approach for correction of congenital cardiac defects despite poor cosmetic results at times. Right anterior minithoracotomy was, therefore, assessed as an alternative procedure with a better cosmetic outcome.

Methods

From October 2002 through February 2007, 75 patients underwent correction of congenital cardiac malformations with the use of cardiopulmonary bypass through right anterior minithoracotomy involving a short incision through the fifth intercostal space and the minimally invasive cannulation. Of them, 18 patients were infants, 42 were children, and 15 were adult. The average age was 9.26 ± 14.1 years (range, 1.2 to 56). The average weight was 19.59 ± 24.3 kg (range, 8.5 to 118 kg). The corrected defects included atrial septal defect type II, sinus venosus atrial septal defect with partial anomalous pulmonary venous drainage, atrial component of atrioventricular septal defect, perimembranous ventricular septal defects with patent foramen ovale, mitral valve repair (complex), repair of cleft mitral valve, cor triatum atrial septal defect, repair of double-chambered right ventricle and extraction of atrial septal defect closure device. Skin incisions were as long as 5 cm.

Results

There was no operative or late mortality or major morbidity. The mean cardiopulmonary bypass time was 58.67 ± 35.11 minutes (range, 32 to 263). Sixty-five patients were extubated in the operating room; the remaining 10 patients were extubated within 4 hours. Cosmetic result was very satisfactory in all patients. Two adult patients complained of some right chest musculoskeletal discomfort.

Conclusions

The right anterior minithoracotomy incision is a safe and effective alternative to a median sternotomy for correction of congenital heart defects. Cosmetic results are highly satisfactory.

Section snippets

Material and Methods

From October 2002 through February 2007, 75 patients underwent open heart operations through a RAMT approach. Age ranged from 1.2 to 56 years (mean, 9.26). Sixty of them were younger than 18 years. Mean body weight was 19.59 ± 24.3 kg (range, 8.5 to 118 kg). Baseline characteristics, type of defect, and surgical procedures are listed in Table 1. Institutional Review Board approval was obtained for the study.

Results

There were no deaths in this series of 75 patients. No patient required conversion to full sternotomy. The mean CPB time was 58.67 ± 35.11 minutes (range, 32 to 263). In 11 patients in whom we used aortic cross-clamp, the mean aortic cross-clamping time was 35.03 ± 24.84 minutes (range, 13 to 142). Sixty-five patients were extubated in the operating room, and the remaining 10 patients were extubated within 4 hours.

Postoperative electrocardiogram showed normal sinus rhythm in all patients.

Comment

Chest scars have significant adverse psychological consequences and social impact on growing boys and girls. The impact is more significant for them than for adult patients. In the current era of a growing interest in minimally invasive surgical techniques in cardiac surgery in general, there is a legitimate desire to adopt these approaches for the pediatric population.

During the last decade, several minimally invasive surgical techniques with or without cardioscopy have been introduced to

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