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Apical Left Ventriculotomy is Safe in Infants and Young Children Requiring Cardiac Surgery
Steven P Goldberg1, Christopher J Knott-Craig, Vijaya M Joshi
1Departments of Pediatric Cardiothoracic Surgery and Pediatric Cardiology, University of Tennessee Health Science Center/Le Bonheur Children's Hospital, Memphis, TN, USA.
Insights
Apical left ventriculotomy in infants showed no deaths and preserved left ventricular function. This cardiac surgery may be a safe option for complex congenital heart defects when other methods are insufficient.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Disease
- Cardiovascular Research
Background:
- Left ventricular incisions historically linked to poor outcomes in infants.
- Current data needed to reassess risks of apical left ventriculotomy in neonates and infants.
Purpose of the Study:
- To evaluate the safety and efficacy of apical left ventriculotomy in infants.
- To determine current outcomes and impact on left ventricular function.
Main Methods:
- Retrospective review of five infants undergoing apical left ventriculotomy (2007-2010).
- Patient data included weight, age, diagnosis, and surgical outcomes.
- Primary endpoint: left ventricular ejection fraction; secondary endpoints: ICU stay, extubation time, inotrope use, arrhythmias, mitral valve function.
Main Results:
- No early or late mortality observed.
- Postoperative ejection fractions remained above 50%, with minimal inotropic support needed for most.
- Short intensive care unit stays (2-5 days) and no significant arrhythmias reported.
Conclusions:
- Apical left ventriculotomy in infants does not appear to significantly impair left ventricular function or cause substantial morbidity in the short term.
- Early results suggest this procedure is a viable option for complex cardiac defects when alternatives are inadequate.
Objectives:
Incisions in the left ventricle have previously been associated with increased mortality and morbidity, particularly in infants. In order to determine whether this assumption is still true in the current era, we reviewed our recent experience with apical left ventriculotomy in neonates and infants.
Methods:
The records of five consecutive patients requiring a left ventriculotomy between 2007 and 2010 were reviewed. Weight and age ranged from 2.6 to 16 kilograms and 5 days to 2 years. The diagnoses were three multiple ventricular septal defects, one rhabdomyoma, and one apical aneurysm. The primary end point was left ventricular ejection fraction, with other end points being intensive care unit length of stay, time to extubation, inotrope requirement, arrhythmias, and mitral valve function.
Results:
There were no early or late deaths. Although lower than their preoperative values, early postoperative ejection fractions were greater than 50% in all patients. Two patients required no inotropes, and 3 required only minimal support. Hospital length of stay was 9 ± 7 days for multiple ventricular septal defect patients, with intensive care unit stays of 2 to 5 days. There were no postoperative arrhythmias requiring pharmacological therapy, and one patient had a significant reduction in mitral insufficiency postoperatively.
Conclusions:
Based on our experience, we believe that an apical left ventriculotomy does not significantly impair left ventricular function even in small infants, and is not associated with significant morbidity, based on short-term follow-up. Although the long-term effects are still unknown, early results suggest that a left ventriculotomy may safely be used when alternative approaches are inadequate for complex cardiac defects.
