How to set-up a program of minimally-invasive surgery for congenital heart defects

Abstract

Minimally invasive pediatric cardiac surgery is becoming a common procedure worldwide. Our schedule to set up a program proves beneficial. The three-step approach has been successful in our experience, allowing a tailored training for every new surgeon and enhancing the enthusiasm in developing further strategies on their own. Recording conversion-rates and complications stands for quality standards. A twofold increase in minimally invasive procedures was observed in two years. The short-medium term results after three years are excellent.

Lessons learned from 10 years of experience with minimally invasive cardiac surgery

“…In the last few years, the use of endoscopic minimally invasive access via mini-thoracotomy to reach different cardiac structures has gained popularity among surgeons who perform minimally invasive cardiac surgery. The steep learning curve and technical difficulties of the different procedural steps such as CPB cannulation, myocardial protection, and deairing maneuvers discourage many surgeons from including these minimally invasive procedures in their routine surgical practice ( 5 ).…”

Minimally Invasive Pediatric Cardiac Surgery is Here to Stay

“…On the other hand, a steep learning curve and technical difficulties in handling some steps (myocardial protection, deairing maneuvers, and so on) discourage many surgeons to include these minimally invasive procedures within their routine practice. Our group has been performing minimally-invasive congenital heart surgery for the last 20 years [24,25]. Sub-mammary incision in adolescent and young ladies was our first approach, which has evolved to a vast array of alternatives including several cardiac conditions since.…”

“…Tables 1 & 2 summarize our group data along the last five years. As experience is gathered, every patient is best suited according body-size and pathology as above mentioned [24,25]. Many groups have shifted towards the minimally invasive surgical approaches in pediatrics [1][2][3][4][5][6][7].…”

“…Currently, the range of incisions different from a full mid-line sternotomy is rich enough to provide us many options. Interestingly, among the literature reviewed, some papers underline the steps to set up programs [25,[28][29][30]. Particularly relevant is the publication by Bonaros et al [31], in which the authors split every procedure in several parts and analyze them separately, so as to accurately depict anyone ś learning curve.…”

“…Our recent experience [25] demonstrates that a comprehensive schedule allows a safe and custom-made approach to train new surgeons in the field and enhances enthusiasm in developing further strategies on their own. A record of conversion-rate and complications should be used as marker of performance and quality standard.…”