Right submammary minithoractomy for repair of congenital heart defects

Objective: The initial experience with the right submammary minithoracotomy incision for correction of intracardiac congenital defects is reported. Me thods: Between March 1997 and March 1999, 100 children underwent repair of congenital heart disease through this approach. Their mean age and weight w ere 4.6 years and 20 kg, respectively. Diagnosis included: atrial septal de fect (78), ventricular septal defect (7), tetralogy of Fallot (6), partial atrioventricular canal (5), double-chambered right ventricle (3) and single ventricle with dextrocardia (1). The standard technique entailed a 5 to 6 cm right submammary incision, entering the chest through the third or fourt h intercostal space (depending on the body weight), direct aortic and bicav al cannulation and aortic cross-clamping with cardioplegic protection. Resu lts: There were no hospital deaths. Postoperative morbidity included bleedi ng in two cases, recurrent atrial septal defect in one, spleen injury in on e. The average hospital stay was 3.5 days. All patient are currently free o f symptoms and medications. Conclusions: (1) This approach for repair of se lected congenital cardiac malformations is technically feasible, safe and e ffective; (2) younger age is a facilitating factor; (3) hospital stays are effectively reduced. (C) 2000 Elsevier Science B.V. All rights reserved.