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Lo Rito M, Brindicci YCM, Moscatiello M, Varrica A, Reali M, Saracino A, Chessa M, Aloisio T, Isgrò G, Giamberti A. Minimally Invasive Surgery for Simple Congenital Heart Defects: Preserving Aesthetics without Jeopardizing Patient Safety. J Cardiovasc Dev Dis 2023; 10:452. [PMID: 37998510 PMCID: PMC10672407 DOI: 10.3390/jcdd10110452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/24/2023] [Accepted: 10/26/2023] [Indexed: 11/25/2023] Open
Abstract
Minimally invasive surgeries for pediatric patients have been proposed for decades, with different approaches in mind. Minimal right axillary thoracotomy (MRAT), proposed two decades ago, allows the preservation of patients' safety alongside faster aesthetic and functional recovery. The MRAT did not become widely adopted due to the prejudice that to follow a minimally invasive approach, safety and efficacy must be compromised. With this study, we aim to compare MRAT to the standard median sternotomy approach with a focus on safety and clinical outcomes. Between January 2017 and April 2021, 216 patients diagnosed with ASD, pAVSD, or PAPVD underwent surgical repair with different approaches in the same period. MRAT was used for 78 patients, and median sternotomy was used for 138 patients. In this last group, standard median sternotomy (SMS) was used for 116 patients, while a minimal skin incision (SMS mini) was used for 22 patients. There were no major complications overall nor in each specific approach. MRAT enabled the successful repair of simple heart defects, providing similar post-operative and cardiological recovery. MRAT does not compromise patients' safety and does not prolong the duration of surgery once the learning curve is overcome, which is generally after 15-20 consecutive operations.
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Affiliation(s)
- Mauro Lo Rito
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy; (Y.C.M.B.); (A.V.); (M.R.); (A.G.)
| | - Ylenia Claudia Maria Brindicci
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy; (Y.C.M.B.); (A.V.); (M.R.); (A.G.)
| | - Mario Moscatiello
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy; (Y.C.M.B.); (A.V.); (M.R.); (A.G.)
| | - Alessandro Varrica
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy; (Y.C.M.B.); (A.V.); (M.R.); (A.G.)
| | - Matteo Reali
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy; (Y.C.M.B.); (A.V.); (M.R.); (A.G.)
| | - Antonio Saracino
- Department of Pediatric and Adult Congenital Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy; (A.S.); (M.C.)
| | - Massimo Chessa
- Department of Pediatric and Adult Congenital Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy; (A.S.); (M.C.)
| | - Tommaso Aloisio
- Department of Cardiothoracic and Vascular Anesthesia and Intensive Care Unit (ICU), IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy; (T.A.); (G.I.)
| | - Giuseppe Isgrò
- Department of Cardiothoracic and Vascular Anesthesia and Intensive Care Unit (ICU), IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy; (T.A.); (G.I.)
| | - Alessandro Giamberti
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy; (Y.C.M.B.); (A.V.); (M.R.); (A.G.)
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Abstract
OBJECTIVES The mini right axillary thoracotomy is an alternative surgical approach to repair certain congenital heart defects. Quality-of-life metrics and clinical outcomes in children undergoing either the right axillary approach or median sternotomy were compared. METHODS Patients undergoing either approach for the same defects between 2018 and 2020 were included. Demographic details, operative data, and outcomes were compared between both groups. An abbreviated quality of life questionnaire based on the Infant/Toddler/Child Health Questionnaires focused on the patient's global health, physical activity, and pain/discomfort was administered to all parents/guardians within two post-operative years. RESULTS Eighty-seven infants and children underwent surgical repair (right axillary thoracotomy, n = 54; sternotomy, n = 33) during the study period. There were no mortalities in either group. The right axillary thoracotomy group experienced significantly decreased red blood cell transfusion, intubation, intensive care, and hospital durations, and earlier chest tube removal. Up to 1 month, parents' perception of their child's degree and frequency of post-operative pain was significantly less after the right axillary thoracotomy approach. No difference was found in the patient's global health or physical activity limitations beyond a month between the two groups. CONCLUSIONS With the mini right axillary approach, surrogates of faster clinical recovery and hospital discharge were noted, with a significantly less perceived degree and frequency of post-operative pain initially, but without the quality of life differences at last follow-up. While providing obvious cosmetic advantages, the minimally invasive right axillary thoracotomy approach for the surgical repair of certain congenital heart lesions is a safe alternative to median sternotomy.
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Vida VL, Zanotto L, Zanotto L, Tessari C, Padalino MA, Zanella F, Pittarello D, Stellin G. Minimally invasive surgery for atrial septal defects: a 20-year experience at a single centre. Interact Cardiovasc Thorac Surg 2019; 28:961-967. [DOI: 10.1093/icvts/ivz017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 12/21/2018] [Accepted: 12/27/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Vladimiro L Vida
- Paediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Lorenza Zanotto
- Paediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Lucia Zanotto
- Department of Statistical Sciences, University of Padua, Padua, Italy
| | - Chiara Tessari
- Paediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Massimo A Padalino
- Paediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Fabio Zanella
- Cardiac Perfusion Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Azienda Ospedaliera of Padua, University of Padua, Padua, Italy
| | - Demetrio Pittarello
- Cardiac Anesthesia Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Giovanni Stellin
- Paediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
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Transverse Split Sternotomy: A Mini-Invasive Approach for Repair of Congenital Cardiac Defects. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2018; 12:275-281. [PMID: 28598874 DOI: 10.1097/imi.0000000000000375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE In this article, we aim to review our mini-invasive technique of transverse sternal split (TSS) with or without cervical cannulation for cardiopulmonary bypass (CPB), its usefulness, and efficiency for repair of congenital cardiac defects. METHODS Between January 2013 and June 2015, 34 infants and small children were operated through TSS in third or fourth intercostal space [Tetralogy of Fallot 11, perventricular ventricular septal defect (VSD) device closure 23]. Cardiopulmonary bypass was established through cervical (common carotid artery [CCA] and internal juglar vein [IJV]) and inferior vena cava cannulation. In patients operated on CPB, near-infrared spectroscopy was monitored during surgery for cerebral oxygenation and Doppler ultrasonography was performed postoperatively for patency of CCA and IJV. Patients were followed up after discharge with physical examination and transthoracic echocardiography (TTE). RESULTS Surgical site exposure through TSS was adequate in all patients. There was no significant morbidity, postoperatively or during follow-up except three patients with VSD device closure who required prolonged mechanical ventilation. Cervical cannulation was sufficient for arterial inflow in all patients operated on CPB. There was one mortality and three procedure failures in VSD device closure group. There was no incidence of neurological complication. Both CCA and IJV were patent in all patients operated on CPB. No significant residual defect was found in either group on postoperative transthoracic echocardiography. CONCLUSIONS Transverse sternal split with or without cervical cannulation is a feasible technique for repair of tetralogy of Fallot and perventricular device closure in selected group of infants and small children without compromising the exposure or quality of repair.
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Minimal-invasiver Verschluss von Ventrikelseptumdefekten in der Kinderherzchirurgie. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2018. [DOI: 10.1007/s00398-017-0193-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Garg P, Kumar Bishnoi A, Patel K, Annanthnarayan C, Patel J, Talsariya M, Shah K, Patel S. Transverse Split Sternotomy. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017. [DOI: 10.1177/155698451701200408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Pankaj Garg
- Department of Cardiovascular and Thoracic Surgery, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, India
| | - Arvind Kumar Bishnoi
- Department of Cardiovascular and Thoracic Surgery, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, India
| | - Kartik Patel
- Department of Cardiovascular and Thoracic Surgery, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, India
| | | | - Jigar Patel
- Department of Cardiac Anesthesia, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, India
| | - Malkesh Talsariya
- Department of Cardiovascular and Thoracic Surgery, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, India
| | - Komal Shah
- Department of Medical Research, UN Mehta Institute of Cardiology and Research Center (Affiliated to B. J. Medical College), Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, India
| | - Sanjay Patel
- Department of Medical Research, UN Mehta Institute of Cardiology and Research Center (Affiliated to B. J. Medical College), Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, India
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Jung SH, Gon Je H, Choo SJ, Yun TJ, Chung CH, Lee JW. Right or left anterolateral minithoracotomy for repair of congenital ventricular septal defects in adult patients. Interact Cardiovasc Thorac Surg 2010; 10:22-6. [DOI: 10.1510/icvts.2009.215038] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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