Minimally Invasive Surgery For Congenital Heart Defects In Paediatric Patients: Technique And Results From An Initial Experience
Corazon Mabel Calle Valda, Enrique Garcia Torres, Lorenzo Boni, Javier Arias Dachary, Manuel Melo, Indalecio Cano Novillo, Araceli Garcia Vazquez.
Hospital Universitario 12 de Octubre, Madrid, Spain.
BACKGROUND: In selected cases, minimally invasive approaches in congenital heart surgery have gained popularity and have been associated with better outcomes and lower perioperative morbidity compared with full sternotomy. The aim of this study is to describe our initial experience in starting a new program on minimally invasive pediatric cardiac surgery. METHODS: A retrospective, observational cohort study was performed collecting data from 17 patients undergoing correction of congenital cardiac defects by minimally invasive heart surgery from February 2014 and October 2019. We use three different approaches: limited right anterolateral thoracotomy (LRAT) (n=7), upper-ministernotomy (U-MS) (n=3) and left thoracoscopy (LTS) (n=7). RESULTS: The average age was 6.0 ±4.5 years (range: 2 months-16.4 years). The average weight was 24.3±17.1 kg (range: 7.7- 66 Kg). The corrected defects included secundum atrial septal defect (pericardial patch closure= 4 and direct suturing =2), aortic valve replacement (n=2), vascular ring division (n=5), excision of interventricular septum tumor (1) veno-arterial extracorporeal membrane oxygenation implantation (ECMO) (n=1), permanent pacemaker implantation (n=1) and pleural pericardial window (n=1) (Table 1). The mean cardiopulmonary bypass time was 65.9 ± 27.2 min (range 27 - 114 min) and the mean aortic crossclamping time was 39.4 ± 26.3 min (range 14 - 94 min) in LRAT and U-MS groups. No patient required conversion to full sternotomy. There were no perioperative complications, with the exception of one case with mild left subcutaneous emphysema in the LTS group. Mean ICU stay and hospital stay were 1.1± 0.4 days and 3.1± 0.9 days, respectively. We had zero surgical mortality. The aesthetic results were excellent. Follow-up (mean 28.2 ±17.9 months) was uneventful. CONCLUSIONS: Based on our initial experience we believe that minimally invasive surgery is a safe and effective alternative to a traditional sternotomy for correction of congenital heart defects. Advantages of this approach include less injury, maintaining the continuity and the integrity of the bony thorax, benefits of improved cosmesis, short length of stay, and fast return to normal activity.
| Procedure | Limited right anterolateral thoracotomy | Upper-ministernotomy | Left thoracoscopy |
| OS atrial septal defect closure | 6 | - | - |
| Aortic valve replacement | - | 2 | - |
| Vascular ring division | - | - | 5 |
| Excision of interventricular septum tumor | 1 | - | - |
| Veno-arterial ECMO | - | 1 | - |
| Permanent pacemaker implantation | - | - | 1 |
| Pleural pericardial window | - | - | 1 |
| Total | 7 (41.2%) | 3 (17.6%) | 7 (41.2%) |
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