Correction of congenital heart defects and mitral valve operations using limited anterolateral thoracotomy

Purpose: Median sternotomy, which generally is used as a standard access fo r atrial septal defect (ASD) and mitral valve operations, has a significant risk of postoperative instability/osteomyelitis of the sternum. Moreover, especially in young women, the resulting large scar is a poor cosmetic resu lt that may have adverse psychological consequences. Our presentation sugge sts that these difficulties may be avoided by the use of a less invasive ap proach consisting of a limited anterolateral thoracotomy with standard cann ulation. Material and methods: From June 1997 until December 1999, 13 women, mean ag e 31.9 +/- 9.2 years, with atrial septum defect (n = 8), sinus venosus defe ct with partial anomalous pulmonary venous connection (n = 1), left atrial myxoma (n = 1) or mitral valve regurgitation (n = 3), were scheduled for le ss invasive operation. In all cases a double lumen tube was used for ventil ation. After a submammarian skin incision of about 10 cm a limited anterola teral thoracotomy was performed in the fifth right intercostal space. For c annulation of the ascending aorta a trochar cannula was used. Both caval ve ins were cannulated by angled vena cava catheters. Standard cardiopulmonary bypass was established using normothermia in all patients undergoing opera tions with correction of congenital heart defects and mild hypothermia (32 degreesC) in the three patients undergoing mitral valve operation. Surgery was performed in cardioplegic arrest using Bretschneider's solution. Ail co rrections of congenital heart defects were performed by Goretex(R) patches. Mitral valve reconstruction was carried out in two patients, and one patie nt underwent mitral valve replacement. Results: No complications occurred in any of the 13 patients peri- or posto peratively. Total time of operation was 211.9 +/- 36.0 minutes, the perfusi on time was 77.0 +/- 25.8 minutes, and the aortic cross-clamp time was 51.8 +/- 21.9 minutes. Mean stay in ICU was 1.2 +/- 0.4 days (total hospital st ay: 7.8 +/- 2.2 days). Postoperative thoracic x-ray and cardiac echocardiog raphy/dopplersonography revealed no pathological findings in any patients. Conclusion: Atrial septal defect operations, including partial anomalous pu lmonary venous connection, left atrial myxoma and mitral valve operations, can be performed safely and effectively using a limited anterolateral thora cotomy and standard cannulation technique with excellent cosmetic results.