Vinod A. Sebastian, M.D.1, Kristine J. Guleserian, M.D.2, Steven Leonard, M.D.2, Hisashi Nikaidoh2, Joseph Forbess2.
1UT Southwestern Medical Center at Dallas, Dallas, TX, USA, 2Children's Medical Center Dallas, Dallas, TX, USA.
OBJECTIVE: We report our experience with repair of a variety of congenital heart defects utilizing a ministernotomy incision.
METHODS: A ministernotomy was used in 79 patients with a variety of congenital heart disease from November 2004 to August 2007. Patients included 36 males and 43 females with ages ranging from 1month to 122months(mean age-34.34 months). The weight ranged from 3.5kg to 40kg(mean weight-13.13kg). The approach consisted of a 3-6 cm skin incision over the lower sternum, with division of xiphoid process and lower sternum. Active retraction of the undivided sternum was employed. Caval venous cannulation, aortic cannulation, aortic cross clamping, and aortic root delivery of cardioplegia were all accomplished through this incision. The lesions corrected included atrial septal defect (ASD, n=30, 38%), ventricular septal defect(VSD, n=8, 10.1%), ASD/VSD with additional congenital cardiac lesions(n=36, 45.6%), partial AV canal(n=3, 3.8%), total anomalous pulmonary venous return(n=1, 1.3%), pulmonary valvotomy and pulmonary arterioplasty(n=1, 1.3%).
RESULTS: There were no deaths with one conversion to full median sternotomy(1/79, 1.3%). The mean cardiopulmonary bypass time was 58.73 min, mean aortic cross clamp time was 39.04 minutes. One patient underwent ASD repair with fibrillatory arrest time of 35min. The mean operating time was 170.68 min, average ICU stay was 1.63 days and average hospital stay was 5.01 days. Complications included post-pericardiotomy syndrome requiring medical treatment in two patients, pericardial effusion requiring pericardiocentesis in one patient, pleural effusions requiring additional tube drainage in four patients, reintubation in one patient, and pneumothorax requiring chest tube in one patient. There were no reinterventions for residual cardiac defects.
CONCLUSIONS: We demonstrate the safety and efficacy of ministernotomy for the correction of a range of congenital heart defects with improved cosmetic results. This is now our incision of choice for most defects that require trans-atrial exposure.
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