Upper partial sternal split for pediatric cardiac surgery.
Congenital heart disease
Congenital heart surgery
Minimally invasive surgery
Outcomes
Journal
General thoracic and cardiovascular surgery
ISSN: 1863-6713
Titre abrégé: Gen Thorac Cardiovasc Surg
Pays: Japan
ID NLM: 101303952
Informations de publication
Date de publication:
16 Jan 2024
16 Jan 2024
Historique:
received:
25
07
2023
accepted:
23
11
2023
medline:
16
1
2024
pubmed:
16
1
2024
entrez:
16
1
2024
Statut:
aheadofprint
Résumé
We introduced the use of an upper partial sternal split for pediatric cardiac surgical procedures in our unit in 2016. We report the outcomes of our experience in 51 patients using this approach. From February 2016 to September 2022, 51 patients underwent congenital cardiac surgical procedures using an upper partial sternal split including vascular ring repair (n = 20), subaortic membrane (n = 12), ventricular septal defect closure with aortic valve resuspension (n = 9), aortic arch repair (n = 4), pulmonary artery band (n = 2), pulmonary artery sling (n = 1), supravalvular aortic stenosis (n = 1), aortic valve replacement (n = 1), and pulmonary artery plasty (n = 1). The surgical approach involved a midline skin incision, based on the manubrium, followed by an upper manubriotomy. No special surgical instrumentation was required. Median patient age was 2.9 years (IQR 1.3, 6.0); median body weight was 15 kg (IQR 9.8, 20). There was no mortality and no patient required intraoperative conversion to full sternotomy. One patient required re-exploration for bleeding when the incision was converted to a full sternotomy. There were no wound complications in any patient. Twenty-one patients (41%) were extubated on the table and of the remaining 30 patients, 23 patients (76%) were extubated within 24 h of surgery. Eleven patients did not require intensive care unit (ICU) admission. Median ICU and hospital stay was 1 day (IQR 1, 1.25) and 5 days (IQR 4, 8) ,respectively. An upper partial sternal split approach is straightforward and can be performed safely with a preferable cosmetic result in selected pediatric cardiac operations.
Identifiants
pubmed: 38227106
doi: 10.1007/s11748-023-01996-7
pii: 10.1007/s11748-023-01996-7
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024. The Author(s).
Références
Langer NB, Argenziano M. Minimally invasive cardiovascular surgery: incisions and approaches. Methodist Debakey Cardiovasc J. 2016;12(1):4–9.
doi: 10.14797/mdcj-12-1-4
pubmed: 27127555
pmcid: 4847968
Miceli A, Murzi M, Gilmanov D, Fugà R, Ferrarini M, Solinas M, et al. Minimally invasive aortic valve replacement using right minithoracotomy is associated with better outcomes than ministernotomy. J Thorac Cardiovasc Surg. 2014;148(1):133–7.
doi: 10.1016/j.jtcvs.2013.07.060
pubmed: 24035370
Luo W, Chang C, Chen S. Ministernotomy versus full sternotomy in congenital heart defects: a prospective randomized study. Ann Thorac Surg. 2001;71(2):473–5.
doi: 10.1016/S0003-4975(00)02443-7
pubmed: 11235692
Miyaji K, Hannan RL, Ojito JW, White JA, Burke RP. Minimally invasive resection of congenital subaortic stenosis. Ann Thorac Surg. 2000;69(4):1273–5.
doi: 10.1016/S0003-4975(99)01536-2
pubmed: 10800843
Herrin MA, Zurakowski D, Fynn-Thompson F, Baird CW, del Nido PJ, Emani SM. Outcomes following thoracotomy or thoracoscopic vascular ring division in children and young adults. J Thorac Cardiovasc Surg. 2017;154(2):607–15.
doi: 10.1016/j.jtcvs.2017.01.058
pubmed: 28366551
Yacoub MH, Khan H, Stavri G, Shinebourne E, Radley-Smith R. Anatomic correction of the syndrome of prolapsing right coronary aortic cusp, dilatation of the sinus of valsalva, and ventricular septal defect. J Thorac Cardiovasc Surg. 1997;113(2):253–61.
doi: 10.1016/S0022-5223(97)70321-0
pubmed: 9040618
Ono M, Fukushima N, Ohtake S, Ichikawa H, Kagisaki K, Matsushita T, et al. The clinical pathway for fast track recovery of school activities in children after minimally invasive cardiac surgery. Cardiol Young. 2003;13(1):44–8.
doi: 10.1017/S1047951103000088
pubmed: 12691287
Vida VL, Tessari C, Fabozzo A, Padalino MA, Barzon E, Zucchetta F, et al. The evolution of the right anterolateral thoracotomy technique for correction of atrial septal defects: cosmetic and functional results in prepubescent patients. Ann Thorac Surg. 2013;95(1):242–7.
doi: 10.1016/j.athoracsur.2012.08.026
pubmed: 23063199
Wadhawa VA, Patel KG, Doshi CP, Shah JK, Ramani JA, Garg PD, et al. Direct femoral cannulation in minimal invasive pediatric cardiac surgery. Innovations technology techniques. Cardiothorac Vasc Surg. 2018;13(4):300–4.
Garg P, Bishnoi AK, Patel K, Annanthnarayan C, Patel J, Talsariya M, et al. Transverse split sternotomy. Innovations technology techniques. Cardiothorac Vasc Surg. 2017;12(4):275–81.
Naimo PS, Fricke TA, Donald JS, Sawan E, d’Udekem Y, Brizard CP, et al. Long-term outcomes of complete vascular ring division in children: a 36-year experience from a single institution. Interact Cardiov Th. 2017;24(2):234–9.
Backer CL, Mongé MC, Popescu AR, Eltayeb OM, Rastatter JC, Rigsby CK. Vascular rings. Semin Pediatr Surg. 2016;25(3):165–75.
doi: 10.1053/j.sempedsurg.2016.02.009
pubmed: 27301603
Shinkawa T, Greenberg SB, Jaquiss RDB, Imamura M. Primary translocation of aberrant left subclavian artery for children with symptomatic vascular ring. Ann Thorac Surg. 2012;93(4):1262–5.
doi: 10.1016/j.athoracsur.2011.12.030
pubmed: 22385819
Backer CL, Rigsby CK. Vascular rings: to scope or not to scope. J Thorac Cardiovasc Surg. 2017;154(2):616–7.
doi: 10.1016/j.jtcvs.2017.03.024
pubmed: 28412114
Luciano D, Mitchell J, Fraisse A, Lepidi H, Kreitmann B, Ovaert C. Kommerell diverticulum should be removed in children with vascular ring and aberrant left subclavian artery. Ann Thorac Surg. 2015;100(6):2293–7.
doi: 10.1016/j.athoracsur.2015.06.093
pubmed: 26428693
Backer CL, Mavroudis C, Rigsby CK, Holinger LD. Trends in vascular ring surgery. J Thorac Cardiovasc Surg. 2005;129(6):1339–47.
doi: 10.1016/j.jtcvs.2004.10.044
pubmed: 15942575
Lee MGY, Brink J, Galati JC, Rakhra SS, Konstantinov IE, Cheung MMH, et al. End-to-side repair for aortic arch lesions offers excellent chances to reach adulthood without reoperation. Ann Thorac Surg. 2014;98(4):1405–11.
doi: 10.1016/j.athoracsur.2014.05.007
pubmed: 25042678
Naimo PS, Konstantinov IE. Small incisions for small children: is right lateral thoracotomy a right approach in open heart surgery in infants? Heart Lung Circ. 2016;25(2):104–6.
doi: 10.1016/j.hlc.2015.07.005
pubmed: 26740394
Vieites MG, Cardenas I, Loyola H, Arias LF, Hernandez IG, Martinez-Bendayan I, et al. Lower mini-sternotomy in congenital heart disease: just a cosmetic improvement? Interact Cardiov Th. 2015;21(3):374–8.
doi: 10.1093/icvts/ivv163