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One--Stage Correct Tetralogy of Fallot with Left Prothorax Mini Incision-The Feasibility and Effectiveness
tongjian wang, Bin Qiao, Fengquan Zhang, Yansong Ning, Jifeng Ju, Wenyuan Duan, Biao Si, Meng Zhu, Baowei Shao, Shifeng Liu, Haijie Li.
Jinan mallitary Region general hospital, Jinan, China.

OBJECTIVE: To evaluate the feasibility and effectiveness of the one-stage correction of Tetralogy of Fallot (TOF) with left prothorax mini incision (LPMI).
METHODS: From October 2012 to June 2014, 44 patients with TOF underwent one stage repair through the LPMI with the cardiopulmonary bypass(CPB) via femoral artery and vein cannulation. The clinical data included 20 males and 24 females, mean body weight(14.6±8.4)kg, mean ages (3.9±4.02)years, pre-operative oxygen saturation value (88.1±10.5)% and the McGoon ratio(1.96±0.41). The percutaneous puncture technique was used to make sure all intubations outside of operative field(as the follow figure). The LPMI, a 4 cm horizontal incision on the third intercostals space, was the main operative port. The left heart cannula was placed into the left auricle through the seven intercostals space of midaxillary line of left chest. The aortic cross clamp and cardioplegia cannula were placed through the third intercostals space. A traditional repair of TOF was preformed via the LPMI, including the ventricular septal defect repair with GORE-TEX patch, the reconstruction of right ventricular outflow with autologous pericardium.
RESULTS: All procedures were successful. CPB time was (104.1±20.5)min, aortic cross time was (65.6±11.6)min, volume of pleural drainage was (117.1±51.7) ml within 24hours, the mediam mechanical ventilation time was 16.9 hours , ICU staying time was (2.7±2.3)days and hospitalization time was (8.4±3.2) days. The following up for all patients were 6-24months. There was no later death and severe complications.
CONCLUSIONS: The LPMI with the CPB via femoral artery and vein cannulation is safe, effective and feasible for one stage correction of TOF.

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