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Correction of simple congenital heart defects in infants and children through a minithoracotomy
U Abdel-Rahman1, G Wimmer-Greinecker, G Matheis
1Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt an Main, Germany. abdel-rahman@gmx.de
Insights
Minimally invasive pediatric cardiac surgery using a small right anterolateral thoracotomy is safe for simple congenital heart defects. This technique offers excellent cosmetic results and a suitable alternative for young patients.
Area of Science:
- Pediatric Cardiac Surgery
- Minimally Invasive Techniques
- Congenital Heart Defects
Background:
- Minimally invasive surgery in pediatric cardiac procedures has advanced over the past decade.
- These techniques offer benefits such as improved cosmetic outcomes and potentially better postoperative results.
- Ensuring the safety of these minimally invasive approaches is crucial.
Purpose of the Study:
- To evaluate the safety and efficacy of a minimally invasive approach for pediatric cardiac surgery.
- To assess the outcomes of using a right anterolateral thoracotomy for repairing simple congenital heart defects in children.
Main Methods:
- A cohort of 21 female pediatric patients underwent a right anterolateral thoracotomy.
- Procedures included repair of atrial septum defects, atrioventricular septum defects, and anomalous pulmonary venous connections.
- Skin incisions were limited to 4-7 cm, with options for transthoracic aortic clamping and femoral cannulation.
Main Results:
- No operative or late mortality was observed in the study group.
- Average procedure, bypass, and cross-clamp times were recorded, along with short postoperative ventilation and intensive care unit (ICU) stays.
- The mean hospital stay was 12 days, with one instance of postoperative hemorrhage requiring intervention. All patients achieved New York Heart Association class I postoperatively.
Conclusions:
- A small right anterolateral thoracotomy is a safe and effective minimally invasive option for pediatric cardiac surgery.
- This approach is suitable for managing simple congenital heart defects in children.
- While cosmetic results are superior, further evidence is needed to confirm improved postoperative outcomes.
Background:
Minimally invasive surgical techniques in pediatric cardiac surgery have evolved throughout the last 10 years. Advantages of minimally invasive procedures include excellent cosmetic results and superior postoperative outcome. However, safety of minimally invasive techniques has to be proven.
Methods:
In 21 female infants and children, a right anterolateral thoracotomy was performed. Mean age was 7.1 years (0.5 to 16.6 years) and mean body weight was 20.8 kg (8.3 to 56 kg). The following defects were repaired: atrial septum defect type II (n = 14); partial atrioventricular septum defect (n = 3); partial anomalous pulmonary venous connection (n = 2); ventricular septum defect (n = 2); mitral valve insufficiency (n = 1); and resection of an embolized atrial septum defect occluder (n = 1). In two cases, aortic cross-clamping was performed by using a transthoracic clamp. In 5 patients, femoral cannulation was performed. Skin incisions were limited to 4 to 7 cm.
Results:
There was no operative or late mortality. Mean operation time, bypass time, and aortic cross-clamp time were 138 (95 to 275), 72 (32 to 179), and 35 (12 to 120) minutes, respectively. Mean postoperative mechanical ventilation time, mean intensive care unit stay, and mean hospital stay were 3.9 hours (1 to 12 hours), 1.4 days (1 to 3 days), and 12 days (8 to 18 days), respectively. Postoperative complications included hemorrhage in 1 patient requiring surgical intervention. Mean follow-up period was 13.3 months (1 to 36 months). All patients were in New York Heart Association class I postoperatively. Trivial mitral insufficiency was evident in 1 patient operated for partial atrioventricular septum defect.
Conclusions:
A small right anterolateral thoracotomy as a minimally invasive technique in pediatric cardiac surgery is a safe and suitable alternative in the operative management of simple congenital heart defects. Cosmetic results are superior, however, improved postoperative outcome has to be proven.
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