Minimally invasive cardiac surgery in congenital heart diseases: the new horizon.

Abstract

Introduction: Sternotomy has been the most common approach for the correction of congenital cardiac defects, and questions arise surrounding the safety, feasibility, and cost-effectiveness of implementing minimally invasive techniques in congenital cardiac surgery, despite their global adoption over the past three decades. Nevertheless, the availability of published data from India on this subject remains limited. We aim to describe the techniques and outcomes of minimally invasive cardiac surgery in selected pediatric cases, a subject not previously detailed within the Indian population, and its corresponding surgical setup.

Aims and objectives: To define the safety and efficacy of minimally invasive cardiac surgery (MICS) in the congenital population and provide a preliminary comparison with the open approach.

Methods: From April 2023 to December 2023, we operated on 63 cases of CHDs via a thoracotomy approach. These cases encompassed various conditions, including ostium secundum atrial septal defects (ASDs), partial atrioventricular canal defects, ASD with pulmonary stenosis/right ventricular outflow tract obstruction (ASD + PS/RVOTO), sinus venous ASD (SV ASD), single-ventricle physiology necessitating bidirectional Glenn (BDG), ventricular septal defects (VSDs), and VSD with pulmonary stenosis/right ventricular outflow tract obstruction (VSD + PS/RVOTO). All procedures were performed under general anesthesia using a single-lumen tube. Safety and efficacy parameters were assessed, and a preliminary comparison was drawn with patients undergoing surgery via a conventional sternotomy approach between November 2022 and August 2023.

Results: The average age of our patient population was 8.38 ± 4.05 years, with the youngest being two infants who were 6 months old. The mean duration of cardiopulmonary bypass (CPB) was 86.17 ± 35.12 min. The mean cross-clamp time was 52.74 ± 29.88 min. Postoperatively, there was no mortality or arrhythmia within the study cohort. Patients exhibited minimal postoperative pain, and early mobilization was observed as early as postoperative day (POD) 1. However, two cases presented with significant bleeding attributed to coagulopathy. Noteworthy postoperative complications included pneumonia in a patient with a VSD and recurrent fever in another patient, with no identifiable causative organism upon culture. The median duration of the intensive care unit (ICU) stay following surgery was 2 days, while the median postoperative hospitalization duration was 7 days. Echocardiographic assessments conducted before discharge revealed no significant residual lesions or gradients in cases involving valvular pulmonary stenosis (PS) or resection of the right ventricular outflow tract (RVOT) muscle bundle. Follow-up examinations were performed at 2 weeks, 1 month, and 3 months postoperatively.

Conclusion: Simple congenital cardiac lesions can be safely and effectively repaired by a minimally invasive approach, with good results and without compromising the surgical techniques.

Graphical abstract:

Supplementary information: The online version contains supplementary material available at 10.1007/s12055-024-01830-6.