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OBJECTIVE: We sought to present our experience with minimally invasive techniques (MIT) for surgical repair of various simple congenital heart diseases (CHD) in both pediatric and adult patients.
METHODS: Between January 1998 and December 2013, 722 patients underwent MIT for treating CHD in our Institution. Patient’s hospital outcome according to the type of MIT was evaluated.
RESULTS: Minimally invasive techniques included: 1) mini-sternotomy (MS)(n=379, 52%), 2) right sub-mammary thoracotomy (RST)(n=304, 42%), and right axillary approach (RAA)(n=39, 6%). There 439 females (61%) and 283 males (49%). Median age at surgery was 4.5 years (range 1 month-70 years). Main diagnosis included: 1) atrial septal defect secundum type (n=443, 61%), ventricular septal defect (n=166, 23%), sinus venosus atrial septal defect ± partial anomalous pulmonary venous connection (n=51, 7%), partial atrio-ventricular septal defect (n=45, 6%), other CHDs (n=17, 3%). The majority of patients (n=468, 65%) underwent intra-cardiac repair using induced ventricular fibrillatory arrest; the remaining 254 patients (35%) had a standard cardioplegic arrest. We have recently introduced the routine use of peripheral cardiopulmonary bypass in patients above 15 kg of body weight (n=122) and a newer sternal retraction system. There were no hospital deaths. Fifty-two patients (7.2%) had postoperative complications which were higher in MS patients (n=37, 9.8%) and RAA patients (n=4, 10.3%) when compared to RST patients (n=11, 3.6%)(p=0.001). All patients were discharged home without residual defects. Mean hospitalization time was shorter during the last 2 years of our experience (p=0.01). Median follow-up time was 7 years (1 day - 15 years). There were no late deaths. The vast majority of patients (708/722, 98 %) were in NYHA class I and 692/722 patients (96%) were satisfied with the cosmetic result of surgery. Reasons of un-satisfaction were the presence of a “too long/visible scar” (n=18), a cheloid at the incision level (n=10), asymmetric breast development (n=2).
CONCLUSIONS: The application of MIT for treating pediatric and adult patients with simple CHD proved safe and effective. The constant refinements of our MIT contributed to reduce patient’s surgical trauma, and combined a high standards of clinical outcome to an excellent cosmetic results.