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International Society For Minimally Invasive Cardiothoracic Surgery

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Minimally Invasive Surgical Closure Of Ostium Secundum Atrial Septal Defects In The Pediatric Population
Carlos A. Pardo Pardo, Sr., Ana Pita, Ramon Perez-Caballero, Corazón Calle, Uxue Morgoitio, Juan-Miguel Gil-Jaurena
Hospital General Universitario Gregorio Marañon, Madrid, Spain

BACKGROUND: Introduced almost three decades ago, minimally invasive surgery has spread to influence nearly every type of cardiovascular procedure, including pediatric population. We share the experience of our center in the last eight years, repairing ostium secundum atrial septal defects (OS ASD) with different minimally invasive (MI) approaches.
METHODS AND RESULTS:
Out of 125 children with an OS ASD, 123 have been operated on along eight consecutive years with five different MI surgical techniques, depending of their body-size and irrespective of gender: (30) Lower mini-sternotomy, mainly for children under 15 Kg, (11) Right postero-lateral thoracotomy, (9) Sub-mammary crease incision, (51) Right axillary thoracotomy and (22) video-assisted mini-thoracotomy with peripheral cannulation in children over 31 kg. Gradually, as more experience was gained, the postero-lateral approach was shifted to an axillary one and the sub-mammary incision was swapped to a video-assisted mini-thoracotomy. 105 of the defects were fixed using a patch and 18 with direct closure. No neurological events were detected; a compartment syndrome was reported without residual sequelae. The aesthetic results were excellent.
CONCLUSIONS: Full sternotomy was spared in 98% of our patient with OS ASD. Minimally-invasive approaches in the pediatric cardiac patients are feasible and safe. The wide range of incisions enables us to customize the most appropriate one, depending on body size. Cosmetic results are outstanding.

Table 1: L-Ms: Lower mini-sternotomy, AX: Right axillary thoracotomy, R-PLT: Right poste-ro-lateral
Approach<15 Kg16-30kg>31Total
L-Ms272130
Ax2028351
R-PLT46111
S-M639
VATS31922
Total514527123


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