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Upper partial sternal split for pediatric cardiac surgery.

Fumiaki Shikata1,2,3, Jay Shah1,4,5, Supreet Marathe1,2,3

  • 1Queensland Pediatric Cardiac Service, Queensland Children's Hospital, Level 7F, Clinical Directorate, PO Box 3474, South Brisbane, QLD, 4101, Australia.

General Thoracic and Cardiovascular Surgery
|January 16, 2024
PubMed
Summary

The upper partial sternal split is a safe and effective approach for pediatric cardiac surgery, showing no mortality and favorable outcomes. This minimally invasive technique offers cosmetic benefits for young patients undergoing complex heart procedures.

Keywords:
Congenital heart diseaseCongenital heart surgeryMinimally invasive surgeryOutcomes

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Area of Science:

  • Cardiovascular Surgery
  • Pediatric Cardiac Surgery
  • Thoracic Surgery

Background:

  • The sternum is a common surgical approach for pediatric cardiac procedures.
  • Minimally invasive techniques are increasingly preferred in pediatric cardiac surgery.

Purpose of the Study:

  • To evaluate the safety and outcomes of an upper partial sternal split in pediatric cardiac surgery.
  • To assess the feasibility of this approach for various congenital heart defects.

Main Methods:

  • A retrospective review of 51 pediatric patients who underwent cardiac surgery using an upper partial sternal split from 2016 to 2022.
  • Procedures included vascular ring repair, subaortic membrane resection, VSD closure, and aortic arch repair.
  • The approach involved a midline skin incision and upper manubriotomy without specialized instruments.

Main Results:

  • No mortality was observed in the study cohort.
  • One patient required re-exploration for bleeding after conversion to a full sternotomy; no wound complications occurred.
  • 41% of patients were extubated in the operating room, and 76% of the remainder were extubated within 24 hours. 11 patients did not require ICU admission.

Conclusions:

  • The upper partial sternal split is a straightforward and safe surgical approach for selected pediatric cardiac operations.
  • This technique offers a preferable cosmetic result compared to full sternotomy.
  • The approach is associated with reduced ICU and hospital stays.