MINIMALLY INVASIVE CARDIAC SURGICAL TECHNIQUES IN THE CLOSURE OF VENTRICULAR SEPTAL-DEFECT - AN ALTERNATIVE APPROACH

Background. Minimally invasive cardiac surgical techniques recently ha ve been applied in the management of a variety of intracardiac lesions . Methods. Fourteen patients (6 boys and 8 girls; age, 8.9 +/- 5.5 yea rs; body weight, 29.0 +/- 13.5 kg) were operated on using minimally in vasive cardiac surgical techniques for the closure of a ventricular se ptal defect (subarterial in 11 patients and perimembranous in 3 patien ts). The operations were performed through a left anterior minithoraco tomy and were guided by video-assisted endoscopic techniques under fem orofemoral cardiopulmonary bypass. The myocardium was protected by con tinuous coronary perfusion with hypothermic fibrillatory arrest. The r ight ventricular outflow tract was entered after pericardiotomy was pe rformed. Results. Closure of the defect (directly in 4 patients and by patch in 10 patients) was performed successfully in all patients. A r ight ventricular outflow tract obstruction and ruptured sinus of Valsa lva aneurysm also were repaired in 1 patient each. The duration of car diopulmonary bypass was 41 +/- 10 minutes (range, 28 to 100 minutes) a nd the total operative time was 2.2 +/- 0.8 hours (range, 1.3 to 3.5 h ours). All the patients recovered rapidly from their operation and had an uneventful postoperative course. Follow-up (mean, 6.2 months; rang e, 6 to 9 months) was complete in all patients. There were no late dea ths. Transthoracic echocardiographic examination showed no residual sh unt and no aortic regurgitation in all patients. Conclusions. Our expe rience demonstrates that minimally invasive cardiac surgical technique s are technically feasible and an alternative option for the repair of a ventricular septal defect. (C) 1998 by The Society of Thoracic Surg eons.