Correction of simple congenital heart defects in infants and children through a minithoracotomy

Background. Minimally invasive surgical techniques in pediatric cardiac sur gery have evolved throughout the last 10 years. Advantages of minimally inv asive procedures include excellent cosmetic results and superior postoperat ive outcome. However, safety of minimally invasive techniques has to be pro ven. Methods. In 21 female infants and children, a right anterolateral thoracoto my was performed. Mean age was 7.1 years (0.5 to 16.6 years) and mean body weight was 20.8 kg (8.3 to 56 kg). The following defects were repaired: atr ial. septum defect type II (n = 14); partial atrioventricular septum defect (n = 3); partial anomalous pulmonary venous connection (n = 2); ventricula r septum defect (n = 2); mitral valve insufficiency (n = 1); and resection of an embolized atrial septum defect occluder (n = 1). In two cases, aortic cross-clamping was performed by using a transthoracic clamp. In 5 patients , femoral cannulation was performed. Skin incisions were limited to 4 to 7 cm. Results. There was no operative or late mortality. Mean operation time, byp ass time, and aortic cross-clamp time were 138 (95 to 275), 72 (32 to 179), and 35 (12 to 120) minutes, respectively. Mean postoperative mechanical ve ntilation time, mean intensive care unit stay, and mean hospital stay were 3.9 hours (1- to 12 hours), 1.4 days (1 to 3 days), and 12 days (8 to 18 da ys), respectively. Postoperative complications included hemorrhage in 1 pat ient requiring surgical intervention. Mean follow-up period was 13.3 months (1 to 36 months). All patients were in New York Heart Association class I postoperatively. Trivial mitral insufficiency was evident in 1 patient oper ated for partial atrioventricular septum defect. Conclusions. A small right anterolateral thoracotomy as a minimally invasiv e technique in pediatric cardiac surgery is a safe and suitable alternative in the operative management of simple congenital heart defects. Cosmetic r esults are superior, however, improved postoperative outcome has to be prov en. (C) 2001 by The Society of Thoracic Surgeons.