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Outcomes of Two-Centimeter Incision as A Routine Approach for Ventricular Septal Defect Repair in Infants Less Than 6 months of Age
Zhongdong Hua.
Fuwai Hospital Beijing, Bejing, China.

OBJECTIVE: To retrospectively evaluate the surgical outcomes of ventricular septal defect(VSD) repair in patients less than 6 months of age with the approach of 2-centimeter-long incision and partial sternotomy.
METHODS: From January 2012 to November 2014, 56 infants underwent surgical repairs for VSD through midline minimal incisions and partial sternotomy. The routine incision started from 2cm below the nipples level, going downward with the length of 2 centimeters. Skin flap were then created to expose the lower sternum. Partial sternotomy were performed with regular sternum saw. Thymus were dissected but not removed. The pericardium was opened and was hung up anteriorly and inferiorly. Regular cardiopulmonary bypass was established with aorta and right atrium cannulation. One or two of the venous canulas went through a minimal incision, which would be chest tube site. Regular cross clamp and cardioplegia technique were applied. The age of the patients ranged from 3 months to 6 month old(mean was 5.3 months), with body weight 4.3 to 6.5 kg(mean was 5.2kg). The associated anomalies included left superior vena cava(LSVC), patent ductus arteriosus (PDA), mitral insufficiency and tricuspid insufficiency and subpulmonary stenosis. The cardiopulmonary bypass time ranged from 26 minutes to 71 minutes(mean is 40 minutes), The cross clamp time ranged from 12 minutes to 51 minutes. The length of incision ranged from 1.9 to 2.5 cm(mean 2.2).
RESULTS: There was no mortality and no major complication. Two patients had minimal residual VSDs which did not need intervention. One had mild pneumotoma and two had hematomas which relieved after treatment. During follow-up, all the patients were doing well and did not need any reoperations.
CONCLUSIONS: Surgical outcomes of VSD repair in patients less than 6 months of age with 2-centimeter-long incision are excellent and the cosmetic incision scar is anticipant to leave the patients less psychological concern while they are growing up.


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