Video-assisted cardioscopy for intraventricular repair in congenital heartdisease

Background. Video-assisted thoracoscopic surgical techniques have been wide ly adopted as a means to reduce surgical trauma. By adapting pediatric thor acoscopic instrumentation, we have developed a technique for video-assisted cardioscopy (VAC). We report our experience and describe the technical fea sibility of VAC. Methods. Since June 1995, 409 consecutive patients underwent 431 intracardi ac procedures (ventricular septal defect, 150; tetralogy of Fallot or doubl e outlet right ventricle, 101; atrioventricular canal, 52; subaortic stenos is, 43; valve repair, 50; Rastelli procedure, 12; Konno or Ross Konno opera tion, II; and miscellaneous, 12) using VAC at Miami Children's Hospital. Us ing a prospective database, we tracked outcomes and operative events to del ineate the usefulness and efficacy of this technique. Results. VAC provided clear and precise imaging of small or remote intracar diac structures during repair of congenital heart defects without technical complications. Procedure times and aortic cross-clamp times using VAC were not prolonged. Intraoperative images were collected for every operation, d ocumenting each patient's cardiac anatomy before and after repair. Surgery through small incisions was facilitated. Operative mortality was 1.2% (5 of 409), and no patient required reoperation before discharge. At a mean foll ow-up interval of 22 months, the incidence of reoperation for residual or r ecurrent lesions was 1.2% (5 of 404). Conclusions. Our experience demonstrates the technical feasibility and clin ical utility of routine endoscopic imaging during open heart surgery for co ngenital heart repair. (Ann Thorac Surg 2000;70:730-7) (C) 2000 by The Soci ety of Thoracic Surgeons.