Single incision minimally invasive congenital heart surgery: Insights into program development and outcome

To provide insight into program development, procedural efficacy, and expansion to higher-complexity lesions in a single-center experience with an inception cohort of minimally invasive congenital heart surgery (MICS) patients.

All patients undergoing MICS procedures between April 2018 and August 2024 at our institution were included. MICS was performed through a single right vertical mini-thoracotomy. Most cases were performed with central cannulation. We recorded demographic data, lesion and procedure type, intraoperative details, and common outcome parameters. Low-risk patients were eligible for a return-to-ward pathway with a 4-hour observation period in the intensive care unit.

A total of 232 MICS patients were included in our analysis. The most common lesions were secundum atrial septal defect (50.0%), partial anomalous pulmonary venous drainage/sinus venosus defect (21.1%), partial atrioventricular septal defect (AVSD; 13.8%), and ventricular septal defect (9.1%). More complex congenital heart diseases included complete AVSD, mitral valve repair, endocarditis, and single ventricle lesions. Simple defects were increasingly repaired by MICS (30.4% in the first year vs 82.1% in the final year). Surgical procedural times were significantly longer in the first half of the study period compared to the second half (P < .005). Procedural times in the last year were shorter by 23.1% compared to the first year of our experience, despite increasing complexity and a wider patient spectrum.

MICS can be performed safely for a wide variety of lesions. Building an MICS program is associated with a steep learning curve but can be achieved with high efficiency and patient satisfaction.