Analysis of 85 Cases of Minimal Media Lower Hemisternotomy for Congenital Cardiac Surgery Under Cardiopulmonary Bypass in Infants
DOI:
https://doi.org/10.1532/hsf.3577Keywords:
congenital heart disease, cardiac surgery, minimally invasive surgery, median sternotomyAbstract
Objective: To investigate the feasibility and effect of minimal media lower hemisternotomy for cardiac surgery under cardiopulmonary bypass (CPB) in infant congenital heart disease.
Methods: In our hospital from May 2019 to October 2019, 170 infants with congenital heart disease underwent surgical treatment (median age 6.6 months; weight 6.0 kg). They were divided into 2 groups: those with conventional chest median incision and those with minimal sternotomy. Minimal lower hemisternotomy began from the third intercostal level and ended 0.5 cm above the xiphoid, just enough to insert a small sternal distractor.
Results: There was no significant difference between the 2 groups in CPB time. The operation time of small incision group was slightly longer (P < .05). There was no difference in prognosis between the 2 groups, but the wound length of the small incision group was significantly reduced (4.0 ± 0.5 versus 7.8 ± 0.8 cm, P < .05). Time of intensive care unit and hospital stay was shorter among hemisternotomy patients at a statistically significant level (P < .05).
Conclusion: Minimal media lower hemisternotomy with the basic advantages of the sternal incision can expose the various parts of the heart, which meets most cardiac exploration and surgical operation needs, and the incision may still be extended if necessary. Lower hemisternotomy appears to be a safe, effective, and versatile alternative for many surgical interventions in infants with congenital heart disease.
References
Bakir I, Casselman F, Wellens F, et al. Minimally invasive versus standard approach aortic valve replacement: A study in 506 patients. Ann Thorac Surg 2006;81:1599-1604.
Cohn LH, Adams DH, Couper GS, et al. Minimally invasive cardiac valve surgery improves patient satisfaction while reducing costs of cardiac valve replacement and repair. Ann Surg 1997;226:421-428.
Corbi P, Rahmati M, Donal E, et al. Prospective comparison of minimally invasive and standard techniques for aortic valve replacement: Initial experience in the first hundred patients. J Card Surg 2003;18:133-139.
Fleißner F, Salman J, Naqizadah J, Avsar M. Minimally invasive surgery in mitral valve endocarditis. Thorac Cardiovasc Surg 2019;67:637-643.
Ha KJ, Cho WC, Kim WK, Kim JB. A minimally invasive approach for the treatment of mid-aortic syndrome in Takayasu arteritis. Korean J Thorac Cardiovasc Surg 2018;51:399-402.
Hata M, Zittermann A, Hakim-Meibodi K, Börgermann J, Gummert J. Minimally invasive mitral valve repair or replacement for degenerative mitral regurgitation. Interact Cardiovasc Thorac Surg 2018;28:575-580.
Kim BS, Soltesz EG, Cohn LH. Minimally invasive approaches to aortic valve surgery: Brigham experience. Semin Thorac Cardiovasc Surg 2006;18:148-153.
Neves P, Ponce P, Braga P, Vouga L. Minimally invasive aortic coarctation correction and aortic valve replacement without syetnotomy. Rev Port Cir Cardiotorac Vasc 2018;25:127-129.
Reardon MJ, Conklin LD, Philo R, et al. The anatomical aspects of minimally invasive cardiac valve operations. Ann Thorac Surg 1999;67:266-268
