Partial median sternotomy as a minimal access for the closure of subarterial ventricular septal defect

Feasibility of transpulmonary approach
  • Toshifumi Murashita
  • Eiichiro Hatta
  • Tsukasa Miyatake
  • Takehiro Kubota
  • Shigeyuki Sasaki
  • Keishu Yasuda
Original Article

Abstract

Background: Minimally invasive techniques in congenital heart surgery have evolved steadily over the past few years, but documentation in the literature is rare. The majority of reported techniques involve thoracoscopic approach and partial sternotomy. We have employed a lower partial sternotomy as a minimal-access procedure for the closure of subarterial ventricular septal defect, for situation where this approach would be unsuitable for adequate exposure of the pulmonary artery. The purpose of this study is to demonstrate the feasibility and safety of this technique and report its superior cosmetic result. Subjects and Methods: Beginning in 1997, we began approaching the closure of subarterial ventricular septal defect through a lower sternal split incision using a 6 to 10 cm skin opening, associated with a reversed L incision at the left second intercostal space. A total of consecutive 12 patients (6 male and 6 female) have been operated on using this approach. The patients ranged in age from 6 to 21 years (mean, 12.8 ± 5.0 years). The straight cannula with stylet was used for aortic cannulation. Results: There was no mortality or morbidity, except for late pericardial effusion in 4 cases. The durations of cardiopulmonary bypass and aortic cross-clamping ranged from 94 to 206 (mean, 131 ±33) minutes and from 40 to 122 (mean, 70 ± 26) minutes, respectively. Ten of 12 patients were extubated in the operating room, and no patient required blood transfusion. The postoperative hospital stay ranged from 8 to 21 (mean, 13.4 ± 4.2) days. No patient developed deterioration of aortic regurgitation or residual ventricular septal defect. Conclusions: Our experience demonstrates that the lower partial sternotomy for the closure of subarterial ventricular septal defect is technically feasible and can be used with excellent cosmetic results and safety. Although experience is limited and follow-up is relatively short, this less invasive surgical technique may become a beneficial option for the management of subarterial ventricular septal defect.

Index words

minimally invasive cardiac surgery minimal access surgery ventricular septal defect partial sternotomy 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Calafiore AM, Angelini GD, Bergsland J, Salerno TA. Minimally invasive coronary artery bypass grafting. Ann Thorac Surg 1996; 62: 1545–8.PubMedCrossRefGoogle Scholar
  2. 2.
    Cosgrove III DM, Sabik JF. Minimally invasive approach for aortic valve operations. Ann Thorac Surg 1996; 62: 596–7.PubMedCrossRefGoogle Scholar
  3. 3.
    Burke RP, Wernovsky G, Van DVM, Hansen D, Castaneda AR. Video-assisted thoracoscopic surgery for congenital heart disease. J Thorac Cardiovasc Surg 1995; 109: 499–507.PubMedCrossRefGoogle Scholar
  4. 4.
    Shetty RP, Dixit MD, Gan MD, Das MB, Harish R, Kapoor L, et al. Video-assisted closure of atrial septal defect. Ann Thorac Surg 1996; 62: 940–3.PubMedCrossRefGoogle Scholar
  5. 5.
    Chang CH, Lin PJ, Chu JJ, Liu HP, Tsai FC, Lin FC, et al. Video-assisted cardiac surgery in closure of atrial septal defect [see comments]. Ann Thorac Surg 1996; 62: 697–701.PubMedCrossRefGoogle Scholar
  6. 6.
    Lin PJ, Chang CH, Chu JJ, Liu HP, Tsai FC, Su WJ, et al. Minimally invasive cardiac surgical techniques in the closure of ventricular septal defect: an alternative approach. Ann Thorac Surg 1998; 65: 165–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Wilson WJ, Ilbawi MN, DeLeon SY, Piccione WJ, Tubeszewski K, Cutilletta AF. Partial median sternotomy for repair of heart defects: a cosmetic approach. Annals of Thoracic Surgery 1992; 54: 892–3.PubMedCrossRefGoogle Scholar
  8. 8.
    Tatebe S, Eguchi S, Miyamura H, Nakazawa S, Watanabe H, Sugawara M, et al. Limited vertical skin incision for median sternotomy. Annals of Thoracic Surgery 1992; 54: 787–8.PubMedCrossRefGoogle Scholar
  9. 9.
    Komai H, Naito Y, Fujiwara K, Takagaki Y, Nishimura Y, Kawasaki S, et al. Lower midline skin incision and minimal sternotomy. A more cosmetic challenge for pediatric cardiac surgery. Cardiology in Young 1996; 6: 76–9.Google Scholar
  10. 10.
    Rosengart TK, Stark JF. Repair of atrial septal defect through a right thoracotomy. Ann Thorac Surg 1993; 55: 1138–40.PubMedCrossRefGoogle Scholar
  11. 11.
    Black MD, Freedom RM. Minimally Invasive repair of atrial septal defect. Ann Thorac Surg 1998; 65: 765–7.PubMedCrossRefGoogle Scholar
  12. 12.
    Barbero-Marcial M, Tanamati C, Jatene MB, Atik E, Jatene AD. Transxiphoid approach without median sternotomy for the repair of atrial septal defects. Ann Thorac Surg 1998; 65: 771–4.PubMedCrossRefGoogle Scholar
  13. 13.
    del Nido PJ, Bichell DP. Minimal-access surgery for congenital heart defects. Seminars in Thoracic and Cardiovascular Surgery: Pediatrice Cardiac Surgery Annual 1998 1988; 1: 75–80.Google Scholar

Copyright information

© The Japanese Society of Thoracic and Cadiovascular Surgery 1999

Authors and Affiliations

  • Toshifumi Murashita
    • 1
  • Eiichiro Hatta
    • 1
  • Tsukasa Miyatake
    • 1
  • Takehiro Kubota
    • 1
  • Shigeyuki Sasaki
    • 1
  • Keishu Yasuda
    • 1
  1. 1.Department of Cardiovascular SurgeryHokkaido University School of MedicineSapporoJapan

Personalised recommendations