Thorac Cardiovasc Surg 2002; 50(5): 271-275
DOI: 10.1055/s-2002-34582
Original Cardiovascular
Original Paper
© Georg Thieme Verlag Stuttgart · New York

Minimally Invasive Surgery for Congenital Heart Defects in Paediatric Patients

A.  R.  Tiete1 , J.  S.  Sachweh1 , R.  Kozlik-Feldmann2 , H.  Netz2 , B.  Reichart1 , S.  H.  Daebritz1
  • 1Department of Cardiac Surgery, University Hospital Großhadern, Munich, Germany
  • 2Department of Pediatric Cardiology, University Hospital Großhadern, Munich, Germany
Further Information

Publication History

Received August 22, 2002

Publication Date:
08 October 2002 (online)

Abstract

Background: In selected cases, minimally-invasive approaches are favoured for the correction of congenital heart defects with regard to better cosmetic results. Methods: Between July 1999 and April 2001, 25 children (9 male; mean age 5.8 ± 4.1 years; mean weight 19.6 ± 12.6 kg) were operated on using minimally invasive approaches. Diagnoses were: ASD (n = 19), VSD (n = 2), ostium primum defect (n = 3) and Tetralogy of Fallot (n = 1). Female patients with ASD underwent a limited right anterolateral thoracotomy. A ministernotomy was chosen in male patients, in patients under 6 months of age, and in patients with malformations other than ASD. Cannulation was always performed via the chest incision. Results: There were no perioperative complications. Mean operation time was 3.23 ± 0.89 h. Twelve patients were extubated immediately after surgery, mean ventilation time in the others was 12.1 ± 11.7 h. Mean ICU stay and hospital stay were 1.5 ± 0.75 days and 8.3 ± 2.2 days, respectively. Follow-up (mean 4.8 ± 4.6 months) was uneventful. Conclusions: Intracardiac repair of some congenital heart defects can be performed safely and effectively via minimally-invasive approaches. Indications are expanding towards more complex defects. Exposure for precise repair is good, additional incisions can be avoided, and cosmetic results have been excellent.

References

  • 1 Cohn L H, Adams D H, Couper G S, Bichell D P, Rosborough D M, Sears S P, Aranki S F. Minimally invasive cardiac valve surgery improves patient satisfaction while reducing costs of cardiac valve replacement and repair.  Ann Surg. 1997;  226 421-428
  • 2 Nicholson I A, Bichell D P, Bacha E A, del Nido P J. Minimal sternotomy approach for congenital heart operations.  Ann Thorac Surg. 2001;  71 469-472
  • 3 Bauer M, Alexi-Meskishvilli V, Nakic Z, Redzepagic S, Bauer U, Wenq Y, Hetzer R. The correction of congenital heart defects with less invasive approaches.  Thorac Cardiovasc Surg. 2000;  48 67-71
  • 4 Luo W J, Chunfang C, Chen S. Ministernotomy versus full sternotomy in congenital heart defects: a prospective randomized study.  Ann Thorac Surg. 2001;  71 473-475
  • 5 Bichell D P, Tal Geva, Bacha E A, Mayer J E, Jonas R A, del Nido P J. Minimal access approach for the repair of atrial septal defect: the initial 135 patients.  Ann Thorac Surg. 2000;  70 115-118
  • 6 Black M D, Freedom R M. Minimal invasive repair of atrial septal defects.  Ann Thorac Surg. 1998;  65 765-767
  • 7 Luciani G B, Piccin C, Mazzucco A. Minimal-access median sternotomy for repair of congenital heart defects.  J Thorac Cardiovasc Surg. 1998;  116 357-358
  • 8 Giamberti A, Mazzera E, di Chiara L, Ferretti E, Pasquini L, di Donate R M. Right submammary minithoracotomy for repair of congenital heart defects.  Eur J Cardiothorac Surg. 2000;  18 678-682
  • 9 Däbritz S, Sachweh J, Walter M, Messmer B J. Closure of atrial septal defects via limited right anterolateral thoracotomy as a minimal invasive approach in female patients.  Eur J Cardiothorac Surg. 1999;  15 18-23
  • 10 Grinda J M, Folliguet T A, Dervanian P, Mace L, Legault B, Neveux J Y. Right anterolateral thoracotomy for repair of atrial septal defect.  Ann Thorac Surg. 1996;  62 175-178
  • 11 Rosengart T K, Stark J F. Repair of atrial septal defect through a right thoracotomy.  Ann Thorac Surg. 1993;  55 1138-1140
  • 12 Dietl C A, Torres A R, Favaloro R G. Right submammarian thoracotomy in female patients with atrial septal defects and anomalous pulmonary venous connections: comparison between the transpectoral and subpectoral approaches.  J Thorac Cardiovasc Surg. 1992;  104 723-727
  • 13 Lancaster L L, Mavroudis C, Rees A H, Slater A D, Ganzel B L, Gray L A. Surgical approach to atrial septal defect in the female: right thoracotomy versus sternotomy.  Am Surg. 1990;  56 218-221
  • 14 Berreklouw E, Alfieri O. Revival of right thoracotomy to approach atrio-ventricular valves in reoperations.  Thorac Cardiovasc Surg. 1984;  32 331-333
  • 15 Praeger P I, Pooley R W, Moggio R A, Somberg E D, Sarabu M R, Reed G E. Simplified method for reoperation on the mitral valve.  Ann Thorac Surg. 1989;  48 835-837
  • 16 Cohn L H, Peigh P S, Sell J, DiSesa V J. Right thoracotomy, femorofemoral bypass, and deep hypothermia for re-replacement of the mitral valve.  Ann Thorac Surg. 1989;  48 69-71
  • 17 Cherup L L, Siewers R D, Futrell J W. Breast and pectoral maldevelopment after anterolateral and posterolateral thoracotomies in children.  Ann Thorac Surg. 1986;  41 492-497
  • 18 Barbero-Marcial M, Tanamati C, Jatene M B, Atik E, Jatene A D. Transxiphoid approach without median sternotomy for the repair of atrial septal defects.  Ann Thorac Surg. 1998;  65 771-774
  • 19 Hagl C, Stock U, Haverich A, Steinhoff G. Evaluation of different minimally invasive techniques in pediatric cardiac surgery: is a full sternotomy always a necessity?.  Chest. 2001;  119 622-627
  • 20 Rao V, Freedom R M, Black M D. Minimally invasive surgery with cardioscopy for congenital heart defects.  Ann Thorac Surg. 1999;  68 1742-1745
  • 21 Chang C H, Lin P J, Chu J J, Liu H P, Tsai F C, Lin F C, Chiang C W, Su W J, Yang M W, Tan P PC. Video-assisted cardiac surgery in closure of atrial septal defect.  Ann Thorac Surg. 1996;  62 697-701
  • 22 Lin P J, Chang C H, Chu J J, Liu H P, Tsai F C, Su W J, Yang M W, Tan P PC. Minimally invasive cardiac surgical techniques in the closure of ventricular septal defect: an alternative approach.  Ann Thorac Surg. 1998;  65 165-170
  • 23 Ying-long L, Hong-jia Z, Han-shong L, Jun-wu S, Cun-tao Y. Correction of cardiac defects through a right thoracotomy in children.  J Thorac Cardiovasc Surg. 1998;  116 359-361
  • 24 Laussen P C, Bichell D P, McGowan F X, Zurakowski D, DeMaso D R, del Nido P J. Postoperative recovery in children after minimum versus full-length sternotomy.  Ann Thorac Surg. 2000;  69 591-596

MD A. R. Tiete

Department of Cardiac Surgery, Großhadern University Hospital

Marchioninistr. 15

81377 Munich

Germany

Phone: +49 (89) 70 95 23 57

Fax: +49 (89) 70 95 88 73

Email: atiete@hch.med.uni-muenchen.de

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