Role of limited posterior thoracotomy for open-heart surgery in the current era

Background. The earliest open-heart operations were performed employing the thoracotomy approach. Over the years, median sternotomy has become the rou tine way of approaching the heart. However, lately there has been progressi ve enthusiasm in minimally invasive techniques for accessing the heart. We present our technique of correction of congenital heart defects employing t he limited posterior thoracotomy approach. Methods. From June 1997 to April 1998, 27 patients underwent correction for various intracardiac defects without any mortality. There were 19 ostium s ecundum defects, with or without other associated anomalies. There were six sinus venosus defects with partial anomalous pulmonary venous connections. Two patients had perimembranous ventricular septal defects, while 2 patien ts had partial atrioventricular defects. In 2 other patients, pulmonary ste nosis was repaired, using pulmonary valvotomy in 1 patient, whereas the oth er patient required short transannular patch. Results. The median age was 7 years and the median weight was 20 kg. The me dian skin-to-skin time was 260 minutes. The median bypass time was 63.25 mi nutes and the median cross-clamp time was 35.0 minutes. All the patients we re extubated within 12 hours following surgery and the median ICU stay was 24 hours. Three patients required blood transfusions in the ICU for signifi cant blood loss and the mean chest drainage was 85 cc per 24 hours. None of the patients had phrenic nerve palsies. None of the patients required addi tional analgesics other than routine ibuprofen or ketorolac tromethamine. S hort-term follow-up revealed no functional or physical disability of the th oracic wall and the right arm. All who underwent surgery with this approach were happy with the limited visibility of their scars. Conclusions. Limited posterior thoracotomy offers a viable alternative for midsternotomy and submammary thoracotomy. It has the advantage of a scar in the back that does not impede the future growth of the breast tissue and t he pectoralis major. Our approach does not need any new instruments and hen ce no contraptions are necessary to perform the operation with this approac h. Our results have shown satisfactory short-term results and better cosmes is. (C) 1999 by The Society of Thoracic Surgeons.