Application of Lower Sternal Incision with On-Pump, Beating Heart Intracardiac Procedures in Congenital Heart Disease

Authors

  • Wei Cheng
  • Yingbin Xiao
  • Lin Chen
  • Hong Liu
  • Yun Zhu

DOI:

https://doi.org/10.1532/HSF98.20111189

Abstract

Background: The purpose of this study was to explore the application of lower sternal incision with on-pump, beating heart intracardiac procedures for the treatment of congenital heart disease.

Methods: A total of 106 cases with congenital heart disease were performed with lower sternal incision under the beating heart condition. The sternum was sawed open to the third sternocostal joint through a small incision in the lower sternum. Cardiopulmonary bypass was developed without aortic cross-clamping. The simultaneous left atrium and ventricle suction and integrating sequential deairing procedure was established to improve the exposure of the surgical field and intraoperative de-airing. We also randomly selected 100 patients with similar disease and age as controls. These control patients underwent middle sternal incision surgery with arresting heart.

Results: The results showed that all the patients were successfully completed with the surgery without death and serious complications, eg, air embolism, residual shunt, and complete atrioventricular block. The operative and cardiopulmonary bypass time in the experimental group was not significantly different from that in the control group. The length of the skin incision in the experimental group was shortened by 4.8 cm compared to that in the control group. The incidence of sternal deformity in patients under 3 years old in the experimental group was significantly lower than that in the control group.

Conclusions: Lower sternal incision with beating heart can reduce the surgical injury, simplify the operation procedure, and improve the therapeutic efficacy. It is a safe and effective approach for the treatment of congenital heart disease.

References

Chan CY, Chiu IS, Wu SJ, Hung CR. 2001. A minimal transverse incision with low median sternotomy for pediatric congenital heart surgery. Eur J Cardiothorac Surg 19:290-3.nKomai H, Naito Y, Fujiwara K, Noguchi Y. 2002. Cosmetic benefits of lower midline skin incision for pediatric open heart operation. A review of 100 cases. Jpn J Thorac Cardiovasc Surg 50:55-8.nNicholson IA, Bichell DP, Bacha EA, del Nido PJ. 2001. Minimal sternotomy approach for congenital heart operations. Ann Thorac Surg 71:469-72.nBleiziffer S, Schreiber C, Burgkart R, et al. 2004. The influence of right anterolateral thoracotomy in prepubescent female patients on late breast development and on the incidence of scoliosis. J Thorac Cardiovasc Surg 127:1474-80.nMurala JS, Agarwal R, Cherian KM. 2005. Effect of right anterolateral thoracotomy on breast development and scoliosis. J Thorac Cardiovasc 129:1462.nNiinami H, Takeuchi Y, Ichikawa S, Suda Y. 2001. Partial median sternotomy as a minimal access for off-pump coronary artery bypass grafting: feasibility of the lower-end sternal splitting approach. Ann Thorac Surg 72:S1041-5.nNiinami H, Takeuchi Y, Suda Y, Ross DE. 2000. Lower sternal splitting approach for off-pump coronary artery bypass grafting. Ann Thorac Surg 70:1431-3.nBorowski A, Korb H. 1997. Myocardial protection by pressure- and volume-controlled continuous hypothermic coronary perfusion (PVC-CONTHY-CAP) in combination with ultra-short beta-blockade and nitroglycerine. Thorac Cardiovasc Surg 45:51-4.nMo A, Lin H, Wen Z, Lu W, Long X, Zhou Y. 2008. Efficacy and safety of on-pump beating heart surgery. Ann Thorac Surg 86:1914-8.nWan S, DeSmet JM, Barvais L, Goldstein M, Vincent JL, LeClerc JL. 1996. Myocardium is a major source of proinflammatory cytokines in patients undergoing cardiopulmonary bypass. J Thorac Cardiovasc Surg 112:806-11.nKaradeniz U, Erdemli O, Yamak B, et al. 2008. On-pump beating heart versus hypothermic arrested heart valve replacement surgery. J Card Surg 23:107-13.nXiao YB, Chen L, Wang XF, et al. 2001. Clinical analysis of on-pump, beating-heart intracardiac procedures in 1032 cases. Acta Academiae Medicinae Militaris Tertiae 23:502-4.nMo A, Lin H. 2011. On-pump Beating Heart Surgery. Heart Lung Circ 20:295-304.n

Published

2012-08-23

How to Cite

Cheng, W., Xiao, Y., Chen, L., Liu, H., & Zhu, Y. (2012). Application of Lower Sternal Incision with On-Pump, Beating Heart Intracardiac Procedures in Congenital Heart Disease. The Heart Surgery Forum, 15(4), E236-E239. https://doi.org/10.1532/HSF98.20111189

Issue

Section

Articles

Most read articles by the same author(s)