Minimally Invasive Congenital Heart Surgery through Right Thoracotomy

Yasuhiro Kotani, Sachiko Kawada, Yasuyuki Kobayashi, Naohiro Horio, Yosuke Kuroko, Genya Muraoka, Ayako Miyamoto, Kouki Eto, Susumu Ozawa, Sadahiko Arai, Shingo Kasahara

Okayama University, Okayama, Japan

Date, time and location: 2018.05.25 13:30, Press Hall, 2F

Abstract

Purpose:

Minimally invasive approach by means of right thoracotomy could be beneficial in patients’ QOL. The purpose of this study is to see the surgical outcome of congenital heart surgery through right thoracotomy.

Methods:

In 1137 simple congenital heart surgeries, including atrial septal defect (ASD) and ventricular septal defect (VSD) performed from 1991 to 2017 at our institution, 91 patients who had right thoracotomy approach were retrospectively reviewed. The patient was placed in the left lateral position. For children, longitudinal skin incision was made at axillary region. Submammary skin incision was made in the adult. The chest was entered through the 3^rd or 4^th intercostal space. The cannulation was routinely done through the thoracotomy in children and femoral cannulation was used in the adult when necessary. With a standard cardiopulmonary bypass (CPB), intracardiac repair was performed. At the end of surgery, a small catheter was placed at the intercostal space and pain medication was administered.

Results:

Diagnosis included ASD in 86 patients, VSD in 4 patients, and mitral regurgitation in 1 patient. There was no early and late death. No CPB-related complication was observed and no patient required the conversion to the median sternotomy. In patients having the secondum ASD closure, CPB time in the right thoracotomy group was significantly longer than that in the median sternotomy group (44 [IQR: 34-54] min vs. 36 [30-46] min, p=0.019), while aortic cross clamping time was comparable between right thoracotomy and median sternotomy approach (18 [15-25] min vs. 15 [11-20] min, p=0.071)

Conclusions:

Simple congenital heart surgery, such as ASD, VSD, and mitral regurgitation is safely performed through right thoracotomy. This approach would have a cosmetic advantage without requiring a longer myocardial ischemic time compared to median sternotomy.