Fast-track congenital heart operations: A less invasive technique and early extubation

Many novel techniques have been described for "minimally invasive" congenit al cardiac operations to achieve an improved cosmetic result. There is litt le information on incorporation of such techniques into fast-track congenit al heart operations. Methods. We have developed an approach to fast-track congenital heart opera tions, which includes a cosmetic approach for repair of congenital heart de fects without sacrificing adequate exposure or requiring specialized equipm ent, along with a simple approach to intraoperative anesthetic management t hat allows extubation in the operating room. The heart is exposed through a short midline skin incision and a full median sternotomy. The conventional technique of cannulation is performed. Between October 1997 and January 19 99, 88 patients were operated on with this method, Cardiac anomalies includ ed simple and complex ostium secundum atrial septal defect, sinus venous at rial septal defect, partial atrioventricular septal defect, simple and comp lex ventricular septal defect, and bicuspid aortic valve stenosis. Results. There were no operative or late deaths, The majority of patients w ere extubated in the operating room or within 2 hours of operation. No pati ent underwent reoperation and the mean length of hospital stay was 3.9 days . Sternal instability or wound infection were not observed. Conclusions. We believe that our approach to fast-track congenital heart op eration is safe and effective,The surgical technique provides good exposure and has excellent cosmetic results. Moreover, it is easy to learn and, if necessary, the surgeon can quickly gain direct access to the heart. The ane sthetic management facilitates early tracheal extubation and a shorter dura tion of postoperative stay. (C) 2000 by The Society of Thoracic Surgeons.