Study objectives: A variety of minimally invasive
techniques have been recently introduced in adult cardiac surgery.
Experiences with children and newborns are, however, limited. In this
report, we present our first experiences with different methods of
ministernotomies for closure of atrial septum defect (ASD) and
ventricular septum defect (VSD) in pediatric cardiac patients. Also,
the current literature for different surgical approaches is
Patients and methods: Twenty-five pediatric
patients (range, 4 months to 12 years old) underwent elective ASD or
VSD closure. Surgical access was either without division of the sternum
(group A, n = 5), with partial inferior sternotomy (group B,
n = 5), total sternotomy with limited skin incision (group C,
n = 5), or total sternotomy with full skin incision (group D,
n = 10).
Results: There were no severe
intraoperative complications regarding exposure, cannulation, or
bleeding. Conversion to full sternotomy was not necessary in any
patient. Bypass time and cross-clamp time in groups A, B, and C were
comparable to the standard operation (group D). However, preparation
time was significantly increased in one minimally invasive group (group
A vs group D, p < 0.05). Despite general feasibility, the
transxiphoidal access without sternotomy compromises exposure of the
ascending aorta, resulting in impaired administration of
cross-clamping, cardioplegia, and especially de-airing.
Conclusions: Transatrial pediatric cardiac operations can
be performed without or with limited sternotomy. The partial sternotomy
allows uncompromised exposure of the great vessels and should be
favored over the transxiphoidal approach. The operative access and
perioperative risk is comparable to a classical standard surgical
approach. Advantages include improved cosmetic results in combination
with a high degree of safety.