Minimally Invasive Pediatric Cardiac Surgery With Central Cannulation And Limited Resources.
SURESH BABU KALE1, Punithakumar Ramasamy2, GUNDILAPALLI NARASIMHAIAH CHENNAKESHAVALLU1.
1MEENAKSHI HOSPITAL, THANJAVUR, India, 2MEENAKSHI HOSPITAL, Thanjavur, India.
Background Minimally Invasive Pediatric Cardiac Surgery with direct central cannulation was used as an alternative to median sternotomy for correction of a wide range of cardiac defects with excellent results and satisfactory cosmetic outcome. Materials and Methods From October 2015 to June 2019, 258 patients underwent correction of congenital cardiac malformations with cardiopulmonary bypass through various approaches with central cannulation [Table 1]. Single shot high thoracic epidural injection of 0.25% bupivacaine after induction of general anesthesia provided good peri-operative analgesia. Intra-operative carbon-di-oxide insufflation facilitated deaeration. Results Three patients died of low cardiac output syndrome and two patients were reexplored. Eighty percent patients were extubated in the operating room. The RVOT gradients were satisfactory in patients with RVOT relief [21 ± 4.0 millimeters of Mercury (range 25-15)]. Six patients had residual VSD at discharge and three patients required secondary suturing for wound infection. No chest deformity or breast mal-development was noted at follow-up. Conclusions Minimally invasive surgery with central cannulation is safe and effective for correction of a wide range of congenital heart defects including right ventricular outlet obstructions. Special instruments and resources are not required and hospital stay is short. Cosmetically the scar is satisfactory. Legend: ASD: Atrial septal defect VSD: ventricular septal defect ICR: intracardiac repair for VSD and right ventricular outflow tract obstruction PAVSD: partial atrioventricular septal defect MR: mitral regurgitation CPB: cardiopulmonary bypass AoCC: aortic cross clamp BSA: body surface area Table 1:
| Case Type | Number | CPB Time | AoCC Time | BSA | Weight |
| ASD (all types) | 177 | 61.40 ± 16.09 | 31.64 ± 10.57 | 0.96 ± 0.29 | 25.37 ± 11.44 |
| VSD (all types) | 64 | 83.73 ± 26.69 | 51.64 ± 18.81 | 0.89 ± 0.30 | 22.28 ± 9.34 |
| ICR | 11 | 135.14 ± 50.88 | 94.85 ± 42.89 | 0.93± 0.24 | 24.14 ± 10.58 |
| PAVSD with Severe MR | 6 | 84 ± 16.97 | 52.5 ± 4.94 | 0.98 ± 0.40 | 28.5 ± 13.43 |
| Axillary Thoracotomy | 58 | 70.29 ± 23.87 | 54.75 ± 16.47 | 0.88 ± 0.26 | 21.26 ± 8.23 |
| RAMT | 189 | 68.81 ± 26.15 | 39.27 ± 20.14 | 0.94 ± 0.29 | 25.16 ± 11.45 |
| LMS | 11 | 98.18 ± 33.20 | 62.63 ± 24.90 | 1.01 ± 0.40 | 23.60 ± 11.37 |
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