Minimally Invasive Surgical Repair of Simple Congenital Heart Defects Using the Right Vertical Infra-Axillary Thoracotomy Approach.

IF 1.6 Q2 SURGERY
Dien Minh Tran, Vinh Quang Tran, Mai Tuan Nguyen, Duyen Dinh Mai, Anh Vuong Doan, Son Thanh Hoang, Yasuhiro Kotani, Truong Ly-Thinh Nguyen
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Abstract

Objective: To evaluate the safety and efficacy of surgical repair for patients diagnosed with simple congenital heart defects (CHD) using the minimally invasive right vertical infra-axillary minithoracotomy (RVIAT) approach.

Methods: We retrospectively reviewed the clinical data of consecutive patients who underwent minimally invasive RVIAT for repair of CHD between August 2019 and August 2022. There were 382 patients who underwent 8 primary procedures and were included in this study.

Results: The median age of the patients was 16.2 (interquartile range [IQR], 7.2 to 41.9) months, and the median weight of the patients was 8.8 (IQR, 6.5 to 14) kg. The preoperative diagnoses were as follows: ventricular septal defect, atrial septal defect, partial anomalous pulmonary venous return, partial atrioventricular septal defect, cor triatriatum, complete atrioventricular septal defect, and myxoma. The mean aortic cross-clamp time, bypass time, and operation time were 45.4 ± 19.3 min, 65.6 ± 23.1 min, and 154.5 ± 29.7 min, respectively. There was no in-hospital mortality or conversion to median sternotomy. Two patients (0.5%) required early reoperation; 1 due to postoperative bleeding and 1 for permanent pacemaker implantation. Other complications included trivial residual shunts (23 of 382, 6%), pleural effusion (3 of 382, 0.8%), pneumothorax (0.8%), and wound infection (4 of 382, 1%). There were 2 late noncardiac deaths. Late reoperation was performed on 1 patient with progressive aortic valve regurgitation who required aortic valvuloplasty.

Conclusions: RVIAT is a minimally invasive approach that can be safely performed on patients with simple CHDs. RVIAT may be a good alternative approach for median sternotomy and cardiac intervention.

使用右侧垂直腋下胸廓切开术微创手术修复单纯先天性心脏缺损
目的评估采用微创右垂直腋下小胸廓切开术(RVIAT)对确诊为单纯先天性心脏缺损(CHD)的患者进行手术修复的安全性和有效性:我们回顾性地审查了2019年8月至2022年8月期间接受微创RVIAT修复CHD的连续患者的临床数据。共有 382 例患者接受了 8 次初级手术,并被纳入本研究:患者的中位年龄为16.2(四分位距[IQR]为7.2至41.9)个月,中位体重为8.8(四分位距[IQR]为6.5至14)公斤。术前诊断如下:室间隔缺损、房间隔缺损、部分肺静脉回流异常、部分房室间隔缺损、三尖瓣狭窄、完全性房室间隔缺损和肌瘤。主动脉交叉钳夹时间、分流时间和手术时间的平均值分别为(45.4±19.3)分钟、(65.6±23.1)分钟和(154.5±29.7)分钟。无院内死亡或转为胸骨正中切开术。有两名患者(0.5%)需要提前再次手术,其中一名是由于术后出血,另一名是为了植入永久起搏器。其他并发症包括微不足道的残余分流(382例中有23例,占6%)、胸腔积液(382例中有3例,占0.8%)、气胸(0.8%)和伤口感染(382例中有4例,占1%)。晚期非心源性死亡 2 例。1名主动脉瓣反流患者因主动脉瓣反流进展需要进行主动脉瓣成形术,后期进行了再次手术:结论:RVIAT 是一种微创方法,可安全地用于单纯性心脏病患者。RVIAT可能是胸骨正中切开术和心脏介入治疗的良好替代方法。
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来源期刊
CiteScore
2.00
自引率
6.70%
发文量
80
期刊介绍: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery is the first journal whose main mission is to disseminate information specifically about advances in technology and techniques that lead to less invasive treatment of cardiothoracic and vascular disease. It delivers cutting edge original research, reviews, essays, case reports, and editorials from the pioneers and experts in the field of minimally invasive cardiothoracic and vascular disease, including biomedical engineers. Also included are papers presented at the annual ISMICS meeting. Official Journal of the International Society for Minimally Invasive Cardiothoracic Surgery
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