Individualized strategy of minimally invasive cardiac surgery in congenital cardiac septal defects

Abstract

Background Intracardiac septal defect is repaired using median sternotomy in most centers; however, there are several reports using minimally invasive surgery in both children and adults. This study summarized our strategy of minimally invasive therapy using various lateral mini-thoracotomies in patients with congenital septal defect. Methods In this study, 472 patients who underwent minimally invasive repair of intracardiac septal defects (atrial septal defect, (ASD), ventricular septal defect, (VSD), and atrioventricular septal defect, (AVSD)) from January 2012 to June 2020 were retrospectively reviewed. Those who underwent device closure were excluded. The minimally invasive strategy included three groups: the right sub-axillary vertical incision (RSAVI) group (N = 335, including192 ASDs, 135 VSDs and 8 AVSDs); the right anterolateral thoracotomy (RALT) group (N = 132, including 77 ASDs, 51 VSDs and 4 AVSDs); and the left anterolateral thoracotomy (LALT) group (N = 5, all subpulmonary VSDs). Results Concomitant surgeries included nine cases of right ventricular outflow tract obstruction relief, nine cases of mitral repairs and 37 cases of tricuspid repairs. There was one transition from thoracotomy to sternotomy. Three patients required second pump run for residual lesions (two residual VSD shunts and one mitral regurgitation). The age and body weight of the RSAVI group were significantly lower than those of the RALT and LALT groups (all P < 0.01). No postoperative death was observed. Postoperative complications included one case of chest exploration for bleeding, one case of reoperation due to patch dehiscence during the same admission, one case of transient neural dysfunction, three cases of diaphragmatic paresis and 13 cases of atelectasis. The median stay in the intensive care unit was two days, while the median postoperative hospitalization duration was six days. The echocardiography results before discharge indicated no significant residual lesions. No reoperation, no new onset of chest deformities and no sclerosis were observed during the follow-up. Conclusions Intracardiac septal defects can be safely and effectively repaired by minimally invasive surgery with good cosmetic results. RSAVI is suitable in infants and children, while RALT is more commonly used in adolescents and adults. LALT is an alternative incision to repair subpulmonary VSD.

Health-related quality of life in children with congenital heart disease following interventional closure versus minimally invasive closure

“…The right ventricular wall was then punctured and the occlusion was completed through the right ventricle → VSD → left ventricle. The MIC allows a better depiction of the heart’s anatomy without the restriction of vascular conditions; however, it causes more pain and trauma than IC ( 14 , 16 , 17 ).…”

“…This is a novel surgical technique performed under the guidance of transesophageal bypass with minimal surgical trauma. It is currently increasingly used for the treatment of ventricular septal defect (VSD) and atrial septal defect (ASD) ( 11 – 14 ). In this investigation, we hypothesized that IC results in better postoperative HRQL in children with VSD or ASD than MIC.…”

Minimally Invasive Surgical Repair of a Partial Atrioventricular Canal Defect in a 20-Year-Old Patient—A Case Report and Review of Literature

“…The presence of an easily concealable scar reduces the psychological stress associated with operated heart disease. For this reason, there is a worldwide trend in performing more congenital procedures via thoracotomy, in children as well as in adults [ 13 , 21 , 22 ]. One difference between the two groups is that, in children, central cannulation is easier, due to the short distance between the chest wall and the great vessels.…”

“…The surgical intervention remains the gold standard treatment and it becomes mandatory in the presence of an important left-to-right shunt, cardiomegaly, or significant valvular regurgitation [ 10 , 11 ]. Apart from the traditional approach through midline sternotomy, this lesion is also amenable for correction through a minimally invasive approach, i.e., a right-sided mini-thoracotomy with peripheral cannulation; this alternative technique allows a speedier recovery and better cosmetic results [ 12 , 13 ].…”

Mid-term outcomes of right subaxillary approach versus median sternotomy incision for ventricular septal defect with patent ductus arteriosus

“…The patients were divided into two groups according to the surgical approach used: the right subaxillary approach (group A) and the median sternotomy incision approach (group B). In clinical practice, combining previous literature and the clinical experience of cardiac surgeons [ 6 , 10 , 11 ], patients who met the following inclusion criteria received the right subaxillary approach: age ≥ 6 months, weight ≥ 5 kg, body mass index < 30 kg/m 2 , no severe aortic regurgitation, no respiratory disease, and no history of a right thorax procedure. Other patients received the median sternotomy incision approach.…”