Cardiac surgery by transxiphoid approach without sternotomy

Area of Science:

• Cardiovascular Surgery
• Minimally Invasive Cardiac Surgery
• Congenital Heart Defects

Background:

• Sternotomy is a common approach for cardiac surgery but can lead to significant scarring and patient discomfort.
• The transxiphoid approach offers a potential alternative to minimize surgical trauma and improve cosmetic outcomes.

Purpose of the Study:

• To evaluate the feasibility and preliminary outcomes of the transxiphoid approach for congenital cardiac defect correction.
• To compare the transxiphoid approach with conventional sternal and thoracic approaches.

Main Methods:

• The transxiphoid approach involved xiphoid resection and sternal elevation for access.
• Twenty-six patients with various congenital heart defects (atrial septal defects, ventricular septal defects, atrioventricular septal defects) underwent the procedure.
• A comparative analysis was performed against sternal and thoracic approaches at two institutions.

Main Results:

• The transxiphoid approach resulted in increased aortic cross-clamp and extracorporeal circulation times.
• Patients in the transxiphoid group reported less pain and respiratory discomfort.
• No significant differences were observed in chest drainage or length of hospital stay compared to conventional methods.

Conclusions:

• The transxiphoid approach is a promising alternative to sternotomy for specific cardiac procedures, offering cosmetic and comfort benefits.
• Adequate surgical access is achieved for procedures requiring right atriotomy.
• While cardiopulmonary bypass times are extended, the technique demonstrates potential for reduced trauma and infection risk.