ORIGINAL ARTICLE   

Chirurgia 2018 October;31(5):179-85

DOI: 10.23736/S0394-9508.18.04777-0

Copyright © 2018 EDIZIONI MINERVA MEDICA

lingua: Inglese

The feasibility of minimal invasive surgery in adult congenital heart disease

Ihab M. MOURSI ✉

Department of Cardiothoracic Surgery, Zagazig University Hospital, Zagazig, Egypt

BACKGROUND: Minimally invasive cardiac surgery has been advised for both adults and children to reduce costs related to hospital stay with no incidence of mediastinitis and to improve cosmetic results. Right mini-thoracotomy is widely used for surgical approach of mitral valve surgery. In congenital heart disease, right mini thoracotomy has been used for closure of atrial septal defects, there are few reports of minimally invasive surgery for adult patients with congenital ventricular septal defects.
METHODS: This work compares our operative and mid-term results of adult congenital heart surgery using minimally invasive video-assisted surgery and standard technique. Ten patients underwent minimally invasive surgical (MIS, ASD-VSD) repair (N.=10) (6 ASD and 4VSD) between July 2010 and July 2012. Patients data, procedures, operative techniques, morbidity, mortality and patient satisfaction were calculated, and it was compared to a ten (N.=10) (5 ASD and 5 VSD) patient who underwent the same operation through a standard median sternotomy
RESULTS: There was no in-hospital mortality in both groups. Mean cardiopulmonary bypass (CPB) time in a mini-thoracotomy group was longer than that of sternotomy group (95.0±22.5 min vs. 65.5±10.5 min, P=0.011), but aorta cross-clamping time was not different (43.6±15.0 min in mini-thoracotomy group vs. 42.5±12 min in sternotomy group) (P=0.05). There were neither postoperative mortality nor postoperative complications related to surgery or peripheral cannulation. The mean hospital stay was 3.5 days in the mini-thoracotomy group and 7.1 days in sternotomy group, respectively (P≤0.05). Score on the visual analog scale was lower in MIS, although this difference did not show statistical significance (P≥0.05). Patients returned to normal activity soon with MIS than sternotomy despite the marked variance in MIS (P≤0.05).
CONCLUSIONS: Minimally invasive cardiac surgery using mini-incision can be safely applied to adult congenital heart disease patients irrespective of ASD or VSD type.

KEY WORDS: Adult - Congenital heart defects - Minimally invasive surgical procedures