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Minimal sternotomy approach for congenital heart operations
I A Nicholson1, D P Bichell, E A Bacha
1Department of Cardiovascular Surgery, Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
The Annals of Thoracic Surgery
|March 10, 2001
Summary
Minimal sternotomy is a safe and effective approach for complex congenital heart disease repair in children, offering good exposure and potentially shorter hospital stays without increasing operating times.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Minimally Invasive Cardiac Surgery
Background:
- Minimal access cardiac surgery is increasingly utilized in pediatric populations.
- Experience with atrial septal defect closure has led to applying these techniques to more complex congenital heart defects.
Purpose of the Study:
- To evaluate the efficacy and outcomes of a minimal sternotomy approach for repairing congenital heart defects other than atrial septal defects in children.
Main Methods:
- A retrospective review of 104 children undergoing minimal sternotomy for congenital heart defects (excluding ASDs) from 1996-1999.
- The approach involved a small xiphisternal incision with sternal elevation, allowing cardiopulmonary bypass cannulation through the great vessels.
- Lesions corrected included ventricular septal defects, tetralogy of Fallot, common atrioventricular canal, and mitral valve procedures.
Main Results:
- No operative mortality was observed.
- Mean cardiopulmonary bypass and cross-clamp times were 71 and 40.8 minutes, respectively.
- Complications were infrequent, and the length of stay (4.5 days) tended to be shorter compared to full sternotomy, with no difference in operating times.
Conclusions:
- Minimal sternotomy is a viable surgical option for complex congenital heart defects in pediatric patients.
- This approach provides adequate surgical exposure, particularly for transatrial repairs.
- It does not increase ischemic times and may contribute to reduced hospital stays.
