Video-assisted thoracoscopic surgery for congenital heart disease

Abstract

Video-assisted endoscopic techniques have reduced operative trauma in adult thoracic and general surgery, but applications in children with congenital heart disease have been limited. We report the development of video-assisted thoracic surgery procedures for neonates and infants with cardiovascular disease. Endoscopic instruments and techniques for pediatric cardiovascular procedures were designed and tested in the animal laboratory. Forty-eight operations were subsequently performed in 46 pediatric patients ranging in age from 2 hours to 14 years (median 9 months), weighing from 575 grams to 54 kg (median 8.5 kg). Clinical applications included seven different surgical procedures: patent ductus arteriosus interruption in infants (n = 26) and premature neonates (n = 5), vascular ring division (n = 8), pericardial drainage and resection (n = 3), arterial and venous collateral interruption (n = 2), thoracic duct ligation (n = 2), epicardial pacemaker lead insertion (n = 1), and diagnostic thoracoscopy (n = 1). There was no operative mortality. Technical success, defined as a video-assisted procedure completed without incising chest wall muscle or spreading the ribs, was achieved in 39 of 48 procedures (82%), with thoracotomy required to complete nine procedures. Most patients (22/25, 88%) undergoing elective ductus ligation were extubated in the operating room and discharged from the hospital within 48 hours of the operation. Eight of the last 10 patients having ductus ligation were discharged on the first postoperative day. Residual ductal flow was assessed by (1) transesophageal echocardiography in the operating room (incidence: 0/25, 0%, 70% CL 0% to 7.3%); (2) discharge auscultation (incidence: 1/30, 3%, 70% CL 0.5% to 10.8%); and (3) follow-up Doppler echocardiography (incidence: 3/25, 12%, 70% CL 5.4% to 22.6%). Video-assisted thoracoscopic techniques can be safely applied to pediatric patients with patent ductus arteriosus and vascular rings and may become an effective addition to the staged management of more complex forms of congenital heart disease.

Surgical closure of atrial septal defect Minimally invasive cardiac surgery or median sternotomy?

“…Video-assisted endoscopic techniques have been used in surgical correction of coronary or congenital extracardiac lesions [5,7,8,11,19]. Recently, minimally invasive cardiac surgery (MICS) has been applied to correct intracardiac lesions [9,10,18,20,29].…”

Partial median sternotomy as a minimal access for the closure of subarterial ventricular septal defect

“…Since minimally invasive techniques in congenital heart surgery have evolved over the past few years, thoracoscopic approach and partial sternotomy comprise the majority of technical modifications. [3][4][5][6][7][8][9] The rationale for the use of minimally invasive techniques is based on the reduction of skin and skeletal trauma, decrease in pain and discomfort, and decrease in the length of recovery and medical expenses. In addition, cosmetic outcome in pediatric patients may be more important than that in adult patients.…”

“…In general, thoracoscopic approach or partial sternotomy has been employed in the majority of reported techniques. [3][4][5][6][7][8][9] Since July 1997, we have employed a lower partial sternotomy as a minimal access for the repair of atrial septal defect (ASD), ventricular septal defect (VSD) and double chambered right ventricle. In the transpulmonary repair of subarterial VSD, it is often difficult to obtain adequate exposure of the pulmonary artery with this technique.…”

Recent Trends in Minimally Invasive Cardiac Surgery

“…Video assistance was used first for closed chest IMA harvests and congenital heart operations [14,15,16]. Although Kaneko et al [17] first described the use of video assistance for mitral valve surgery done through a sternotomy, Carpentier et al[ 18] completed the first video-assisted mitral valve repair via a mini-thoracotomy using ventricular fibrillation in February 1996.…”