Minimally invasive repair of atrial septal defects
1Division of Cardiovascular Surgery, The Hospital for Sick Children and The University of Toronto, Ontario, Canada. michael.black@mailhub.sickkids.on.ca
Insights
This study explored a minimally invasive cardiac surgery technique for pediatric atrial septal defect repair, achieving excellent cosmetic results and safety. The approach offers a viable alternative for young patients needing heart defect correction.
Area of Science:
- Pediatric Cardiac Surgery
- Minimally Invasive Techniques
- Congenital Heart Disease
Background:
- Evolving minimally invasive pediatric cardiac surgical techniques face challenges from percutaneous devices for congenital heart disease.
- The demand for "incisionless" operations must be balanced with procedural safety.
Purpose of the Study:
- To evaluate a modified minimally invasive technique for pediatric atrial septal defect repair.
- To assess the safety and cosmetic outcomes of this surgical approach.
Main Methods:
- Twenty-three pediatric patients with atrial septal defects underwent repair using a partial sternal split and a limited skin incision (5-7 cm).
- Procedures were performed between July 1995 and October 1996.
Main Results:
- The average patient age was 6 years and 2 months, with an average weight of 23.3 kg.
- Average cardiopulmonary bypass time was 35 minutes.
- Twenty-two patients had ostium secundum defects and one had a sinus venosus defect, with no operative or late deaths. Average hospital stay was 3.6 days.
Conclusions:
- This modified technique provides an effective cosmetic alternative to traditional submammary and thoracotomy approaches.
- Advantages include excellent cosmetic results across all age groups.
- It offers the security of mediastinal access and the option for full sternotomy if necessary.
Background:
Minimally invasive pediatric cardiac surgical techniques continue to evolve and remain challenged by technologic advances in percutaneous devices developed to treat congenital heart disease exclusive of cardiopulmonary bypass. Public tenacity for "incisionless" operations, however, must remain balanced scrupulously against the collective safety of the surgical procedure.
Methods:
Twenty-three pediatric patients underwent repair of atrial septal defects through a partial sternal split and a limited skin incision (5 to 7 cm) at our institution between July 1995 and October 1996.
Results:
The average age of the patients was 6 years and 2 months (range, 19 months to 15 years) and the average weight was 23.3 kg (range, 11.3 to 61.7 kg). The average bypass time was 35 minutes (range, 19 to 81 minutes). Fourteen patients had a single dose of blood cardioplegia administered, whereas 9 had ventricular fibrillation electrically induced. Twenty-two patients had ostium secundum defects and 1 had a sinus venosus defect. The average length of the hospital stay was 3.6 days (range, 3 to 6 days). There were no operative or late deaths.
Conclusions:
Modifications of this technique continue to evolve as an effective cosmetic alternative to submammary and thoracotomy approaches. Advantages of this modification include excellent cosmetic results in all age groups and the concomitant security and familiarity of mediastinal access and full sternotomy when required.
