Minimal-access surgery for congenital heart defects.

Area of Science:

• Pediatric Cardiac Surgery
• Minimally Invasive Cardiac Surgery
• Congenital Heart Defects

Background:

• Improved surgical outcomes for congenital cardiac defects have driven interest in alternatives to full midline sternotomy.
• Minimally invasive approaches aim to reduce pain, shorten recovery, and improve cosmetic results.
• Previous alternative approaches like anterior thoracotomy have shown variable success and specific limitations.

Purpose of the Study:

• To evaluate the efficacy and safety of a transxyphoid or ministernotomy approach for congenital heart defect repair in children.
• To compare this approach with traditional full sternotomy regarding operative outcomes and complications.

Main Methods:

• A midline incision limited to the xyphoid process, with or without lower sternal division, was used to access the heart and great vessels.
• The technique was applied to 54 children undergoing repair of secundum-type atrial septal defects between May 1996 and June 1997.
• Arterial cannulation was performed via the ascending aorta or femoral artery; cardioplegia and left ventricular venting were utilized.

Main Results:

• The transxyphoid/ministernotomy approach was successfully used in all 54 patients without conversion to full sternotomy.
• Complete repair was achieved with ischemic and bypass times comparable to full sternotomy.
• The technique was also successfully applied to other defects including ventricular septal defects and atrioventricular canal defects.

Conclusions:

• The transxyphoid or ministernotomy approach is a safe and adaptable alternative for minimally invasive repair of various congenital heart defects in children.
• This technique offers comparable surgical results to full sternotomy while potentially improving patient recovery and cosmetic outcomes.
• The ability to extend the incision if necessary adds to its versatility as a preferred surgical option.