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Minimally invasive surgery for congenital heart defects in paediatric patients
A R Tiete1, J S Sachweh, R Kozlik-Feldmann
1Department of Cardiac Surgery, University Hospital Grosshadern, Munich, Germany. atiete@hch.med.uni-muenchen.de
Insights
Minimally-invasive surgery for congenital heart defects in children offers excellent cosmetic results and is safe and effective. This approach is expanding to include more complex cardiac conditions.
Area of Science:
- Pediatric Cardiac Surgery
- Minimally Invasive Cardiac Surgery
- Congenital Heart Defects
Background:
- Minimally-invasive approaches are increasingly favored for congenital heart defect correction.
- These techniques offer improved cosmetic outcomes compared to traditional methods.
Purpose of the Study:
- To evaluate the safety and efficacy of minimally-invasive surgical approaches for congenital heart defects in pediatric patients.
- To assess the feasibility of expanding indications for minimally-invasive cardiac surgery.
Main Methods:
- A cohort of 25 children underwent minimally-invasive surgery between July 1999 and April 2001.
- Procedures included atrial septal defect (ASD), ventricular septal defect (VSD), ostium primum defect, and Tetralogy of Fallot repair.
- Surgical approaches involved limited thoracotomy or ministernotomy with chest incision cannulation.
Main Results:
- No perioperative complications were reported in the study cohort.
- Mean operative time was 3.23 hours, with rapid extubation in 12 patients.
- Mean ICU and hospital stays were 1.5 and 8.3 days, respectively, with uneventful follow-up.
Conclusions:
- Minimally-invasive intracardiac repair of congenital heart defects is safe and effective in children.
- The approach provides excellent exposure for precise repair, avoids additional incisions, and yields superior cosmetic results.
- Indications for minimally-invasive surgery are expanding to encompass more complex congenital heart conditions.
Background:
In selected cases, minimally-invasive approaches are favoured for the correction of congenital heart defects with regard to better cosmetic results.
Methods:
Between July 1999 and April 2001, 25 children (9 male; mean age 5.8 +/- 4.1 years; mean weight 19.6 +/- 12.6 kg) were operated on using minimally invasive approaches. Diagnoses were: ASD (n = 19), VSD (n = 2), ostium primum defect (n = 3) and Tetralogy of Fallot (n = 1). Female patients with ASD underwent a limited right anterolateral thoracotomy. A ministernotomy was chosen in male patients, in patients under 6 months of age, and in patients with malformations other than ASD. Cannulation was always performed via the chest incision.
Results:
There were no perioperative complications. Mean operation time was 3.23 +/- 0.89 h. Twelve patients were extubated immediately after surgery, mean ventilation time in the others was 12.1 +/- 11.7 h. Mean ICU stay and hospital stay were 1.5 +/- 0.75 days and 8.3 +/- 2.2 days, respectively. Follow-up (mean 4.8 +/- 4.6 months) was uneventful.
Conclusions:
Intracardiac repair of some congenital heart defects can be performed safely and effectively via minimally-invasive approaches. Indications are expanding towards more complex defects. Exposure for precise repair is good, additional incisions can be avoided, and cosmetic results have been excellent.