Hemodynamic effects of thoracoscopic surgery in neonates with cardiac anomalies

Thoracoscopic repair of esophageal atresia (EA) and congenital diaphragmatic hernia (CDH) repair is increasing in popularity. However, minimally invasive surgery is avoided in infants with heart defects. The aim of this study was to clarify whether cardiac anomalies are a reasonable contraindication to thoracoscopic surgery in term and preterm neonates.

In this retrospective, single-institution study 15 neonates (8 boys and 7 girls) with cardiac anomalies underwent thoracoscopic repair of either EA or CDH. Between January 2004 until November 2012 4 preterm and 11 term neonates were identified. Type of cardiac anomaly, operative procedure performed, operative time, intrapleural pressure, and early postoperative complications were evaluated.

Over this 9-year period, 10 neonates underwent thoracoscopic EA repair, and 5 neonates underwent thoracoscopic CDH repair. Median operative time was 177 minutes with a median intrapleural pressure of 9 mm Hg. Cardiac anomalies ranged from persistent foramen ovale to atrium septal defect to ventricular septal defect and tetralogy of Fallot. In the postoperative course hemodynamic impairment was noted in only 1 patient. This patient presented cardiorespiratory instability already preoperatively and required dobutamine until postoperative Day 6.

From this experience it appears that thoracoscopic surgery can be performed safely in term and preterm neonates with cardiac anomalies. Even in babies with multiple cardiac anomalies and complex heart defects, thoracoscopic repair of EA or CDH could be performed without hemodynamic instability. Nevertheless, further studies are necessary to gain sufficient information about the effects of thoracoscopy in neonates with heart defects.