Abstract
Objective: We reviewed our experience of minimal access surgery to elucidate the efficacy and safety of this approach and determine the factors affecting hospital stay. Methods: Seventy-seven patients (age, 11.8±11.0 years), with body weight of more than 10 kg, were operated using various forms of minimal access approach for repair of simple congenital heart defects [atrial septal defect (ASD) in 40, ventricular septal defect in 37]. These included lower partial sternotomy (n=68) and mini-thoracotomy (n=9, ASD only) with limited skin incision of 4–11 cm. The anesthetic protocol was modified to wean all patients from ventilator soon after operation. The protocol of discharge from hospital (critical pass) was 14 days in the early period (n=30) and 10 days in the late period (n=47). Results: There were no hospital or late death, and no hospital re-admission. None of patients required blood transfusion. The endotracheal tube was extubated in the operating room in 48 cases (62%). Twenty-four patients (31%) failed to fulfill conditions of the critical pass. Univariate analysis of factors affecting unfavorably the critical pass demonstrated that the median approach, retention of pericardia] effusion and social reasons were statistically significant, while an opened pleura and aortic cross-clamp time were marginally significant Multivariate analysis indicated that the retention of pericardial effusion was the only significant factor that failed critical pass [p=0.007, odds ratio (OR) 5.7,95% confidence interval (CI) 1.61–19.8]. In addition, a pericardio-pleural fenestration was the only significant factor that affected favorably the pericardial effusion (p=0.035, OR 0.2,95%CI 0.47–0.89) by multivariate analysis. Conclusions: Our experience demonstrated that minimal access surgery of the simple congenital heart defects provided excellent cosmetic results. Retention of pericardial effusion, possibly due to pericarditis, was a major risk factor of the prolonged hospital stay. The pericardio-pleural fenestration could reduce the risk of retention of effusion.
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Black MD, Freedom RM. Minimally invasive repair of atrial septal defects. Ann Thorac Surg 1998; 65: 765–7.
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.
Gundry SR, Shattuck OH, Razzouk AJ, del Rio MJ, Sardari FF, Bailey LL. Facile minimally invasive cardiac surgery via ministernotomy. Ann Thorac Surg 1998; 65: 1100–4.
Bichell DP, Geva T, Bacha EA, Mayer JE, Jonas RA, del Nido PJ. Minimal access approach for the repair of atrial septal defect: The initial 135 patients. Ann Thorac Surg 2000; 70: 115–8.
Burke RP. Reducing the trauma of congenital heart surgery. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2001; 4: 216–28.
Luo W, Chang C, Chen S. Ministernotomy versus full sternotomy in congenital heart defects: A prospective randomized study. Ann Thorac Surg 2001; 71:473–5.
Komai H, Naito Y, Fujiwara K, Noguchi Y. Cosmetic benefits of lower midline skin incision for pediatric open heart operation: A review of 100 cases. Jpn J Thorac Cardiovasc Surg 2002; 50: 55–8.
Nicholson IA, Bichell DP, Bacha EA, del Nido PJ. Minimal sternotomy approach for congenital heart operations. Ann Thorac Surg 2001; 71: 469–72.
Murashita T, Hatta E, Miyatake T, Kubota T, Sasaki S, Yasuda K. Partial median sternotomy as a minimal access for the closure of subarterial ventricular septal defect: Feasibility of transpulmonary approach. Jpn J Thorac Cardiovasc Surg 1999; 47: 440–4.
Yozu R, Shin H, Maehara T, Kawada S. Basic approaches in minimally invasive cardiac surgery (MICS) and its selection (Eng abstr). Nippon Geka Gakkai Zasshi 1998; 99: 810–6.
Laks H, Hammond GL. A cosmetically acceptable incision for the median sternotomy. J Thorac Cardiovasc Surg 1980; 79: 146–9.
Bedard P, Keon WJ, Brais MP, Goldstein W. Submammary skin incision as a cosmetic approach to median sternotomy. Ann Thorac Surg 1986; 41: 339–41.
Rosengart TK, Stark JF. Repair of atrial septal defect through a right thoracotomy. Ann Thorac Surg 1993; 55: 1138–40.
Massetti M, Babatasi G, Lotti A, Bhoyroo S, Le Page O, Khayat A. Less-invasive heart surgery: The preservation of median approach. Eur J Cardiothorac Surg 1998; 14 Suppl 1: S138–42.
Wilson WR Jr, Ilbawi MN, DeLeon SY, Piccione W Jr, Tubeszewski K, Cutilletta AF. Partial median sternotomy for repair of heart defects: A cosmetic approach. Ann Thorac Surg 1992; 54: 892–3.
Marianeschi SM, Seddio F, McElhinney DB, Colagrande L, Abella RF, de la Torre T, et al. Fast-track congenital heart operations: A less invasive technique and early extubation. Ann Thorac Surg 2000; 69: 872–6.
Miyaji K, Murakami A, Kobayashi J, Suematsu Y, Takamoto S. Transxiphoid approach for intracardiac repair using video-assisted cardioscopy. Ann Thorac Surg 2001; 71: 1716–8.
Khan JH, McElhinney DB, Reddy VM, Hanley FL. A 5-year experience with surgical repair of atrial septal defect employing limited exposure. Cardiol Young 1999; 9: 572–6.
Schuller JL, Bovill JG, Nijveld A, Patrick MR, Marcelletti C. Early extubation of the trachea after open heart surgery for congenital heart disease: A review of 3 years’ experience. Br J Anaesth 1984; 56: 1101–8.
Cheng DC. Fast track cardiac surgery pathways: Early extubation, process of care, and cost containment. Anesthesiology 1998; 88: 1429–33.
Heinle JS, Diaz LK, Fox LS. Early extubation after cardiac operations in neonates and young infants. J Thorac Cardiovasc Surg 1997; 114: 413–8.
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Murashita, T., Hatta, E., Ooka, T. et al. Minimal access surgery for the repair of simple congenital heart defects. Jpn J Thorac Caridovasc Surg 52, 127–134 (2004). https://doi.org/10.1007/s11748-004-0128-6
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DOI: https://doi.org/10.1007/s11748-004-0128-6