Right mini-thoracotomy approach for grown-up congenital heart disease
Cristina Barbero1, Giovanni Marchetto1, Carlo Pace Napoleone2
1Department of Cardiovascular and Thoracic Surgery, Città della Salute e della Scienza, University of Turin, Torino, Italy.
Insights
Right mini-thoracotomy cardiac surgery is a safe and effective minimally invasive option for grown-up congenital heart (GUCH) disease patients, offering faster recovery and avoiding sternotomy risks, especially in redo cases.
Area of Science:
- Cardiovascular Surgery
- Congenital Heart Disease
- Minimally Invasive Surgery
Background:
- Right mini-thoracotomy cardiac surgery demonstrates excellent outcomes, but its application in congenital heart disease is less explored.
- This study reviews the experience with minimally invasive cardiac surgery in adult congenital heart patients.
Purpose of the Study:
- To evaluate the safety and efficacy of right mini-thoracotomy cardiac surgery in patients with grown-up congenital heart (GUCH) disease.
- To assess outcomes in a cohort of GUCH patients undergoing minimally invasive procedures.
Main Methods:
- Retrospective analysis of 127 GUCH patients undergoing right mini-thoracotomy from 2006-2019.
- Inclusion criteria: atrial septal defect, partial anomalous pulmonary venous return, partial atrioventricular septal defect, and congenital valve dysfunction.
- Focus on outcomes including complications, conversion rates, and postoperative function.
Main Results:
- 127 GUCH patients (mean age 43.6 years, >60% female) underwent the procedure.
- Common diagnoses included atrial septal defect (44.9%); 18.9% were redo cases.
- Zero stroke/major vascular complications, 0.8% conversion to sternotomy, 1.6% perioperative mortality, and no residual shunts or valve dysfunction.
Conclusions:
- Right mini-thoracotomy is a viable approach for selected GUCH patients, minimizing scarring and accelerating recovery.
- This technique is particularly beneficial in redo cases, circumventing sternotomy risks.
- Minimally invasive surgery offers significant advantages for adult congenital heart disease management.
Background:
Right mini-thoracotomy cardiac surgery has been recognized as a safe and effective procedure, with remarkable early and long-terms outcomes. However, most of the literature is focused on mitral valve surgery and few studies report on the minimally invasive approach applied to congenital disease. Aim of this study was to review our experience on patients with grown-up congenital heart (GUCH) undergoing right mini-thoracotomy cardiac surgery.
Methods:
Data of patients with GUCH undergoing right mini-thoracotomy cardiac surgery from 2006 to 2019 were retrospectively analyzed. Inclusion criteria were atrial septal defect, partial anomalous pulmonary venous return, partial atrioventricular septal defect, and mitral or tricuspid valve dysfunction in congenital heart diseases.
Results:
During the study period 127 patients with GUCH underwent right mini-thoracotomy cardiac surgery. Mean age was 43.6 years and more than 60% were females; diagnosis was atrial septal defect in 57 cases (44.9%); 24 patients were redo (18.9%). No cases of stroke and major vascular complications were reported. Conversion to sternotomy was required in one case (0.8%). No residual shunts or valves dysfunction were recorded at the postoperative echocardiographic evaluation. Perioperative mortality was 1.6%.
Conclusions:
Right mini-thoracotomy cardiac surgery in selected patients with GUCH allows to avoid the big scar of the sternotomy approach and to accelerate the recovery in a young population. Moreover, in redo cases, it allows the surgeon to reach the heart and the aorta avoiding the well-known risks of a re-sternotomy procedure.
