The Limiting Factors for the Transxiphoid Approach in Congenital Cardiac Surgery
DOI:
https://doi.org/10.1532/HSF98.20033013Abstract
Objective: Minimally invasive cardiac surgery is currently being performed for a wide variety of cardiothoracic procedures. Since August 1998, the transxiphoid approach using a direct cannulation to the ascending aorta has been selected for the closure of atrial septal defects (ASD) and ventricular septal defects (VSD) in our institution. However, this approach cannot be performed for all patients because of the small "xiphoid window." We analyzed the factors limiting this approach to determine the best factor predicting risk.
Methods: Of 26 patients who had an ASD or a VSD, 14 underwent complete repair using a transxiphoid approach. Preoperative data collected for all patients included the relationship between the right ventricular outflow tract and the lower sternum (the RVSA) in the cineangiograph. Multiple logistic regression analysis was used to investigate which of the factors best predicted whether the transxiphoid approach should be adopted.
Results: The factors best predicting this approach were the combination of RVSA and body surface area (BSA) (odds ratios of 2.982 [P = .018] and 0.925 [P = .046], respectively). With the logistic model used in a prospective study of 6 consecutive patients, we were completely successful in predicting whether the transxiphoid approach could be performed.
Conclusion: The combination of RVSA and BSA was the limiting factor for using the transxiphoid approach in congenital cardiac surgery.
References
Barbero-Marcial M, Tanamati C, Jatene MB, Atik E, Jatene AD. 1998. Transxiphoid approach without median sternotomy for the repair of atrial septal defects. Ann Thorac Surg 65:771-4.nBurke RP, Michielon G, Wernovsky G. 1994. Video-assisted cardioscopy in congenital heart operations. Ann Thorac Surg 58:864-8.nMiyaji K, Hannan RL, Ojito J, Dygert JM, White JA, Burke RP. 2000. Video-assisted cardioscopy for intraventricular repair in congenital heart disease. Ann Thorac Surg 70:730-7.nMiyaji K, Hannan RL, Ojito J, White JA, Burke RP. 2000. Minimally invasive resection of congenital subaortic stenosis. Ann Thorac Surg 69:1273-5.nMiyaji K, Murakami A, Kobayashi J, Suematsu Y, Takamoto S. 2001. Transxiphoid approach for intracardiac repair using a video-assisted cardioscopy. Ann Thorac Surg 71:1716-8.nMurakami A, Kaneko Y, Imanaka K, Takamoto S, Yahagi N. 2000. Easy aortic cannulation: a transxiphoid approach. Artif Organs 24:156-7.nRao V, Freedom RM, Black MD. 1999. Minimally invasive surgery with cardioscopy for congenital heart defects. Ann Thorac Surg 68:1742-5.n
