Limited upper mini-sternotomy approach for closed heart surgery in the newborns and infants.

Abstract

The mini-sternotomy has become a common approach of choice for a wide range of congenital defects requiring minimally invasive surgery. Here, we aimed to present closed heart surgery results via limited upper mini-sternotomy in the newborn and infants. A total of 46 infants who underwent pulmonary artery banding, patent ductus arteriosus ligation, and aortopexy via limited upper mini-sternotomy between December 2017 and October 2020 were enrolled. Patients included 26 males and 20 females with ages ranging from 2days to 12months (median age 3.25 ± 0.9months). The weight ranged from 0.7kg to 8kg (median weight 3.6 ± 1.8kg). These patients were evaluated retrospectively in terms of clinical, preoperative, intraoperative, and postoperative parameters. Closed heart surgery procedures were corrected successfully without adverse events intraoperatively. The median operation time was 32min (32 ± 7min). The limited upper mini-sternotomy was performed on 46 patients, including the pulmonary banding (18 patients), PDA ligation (16 patients), and aortopexy (12 patients). No patients required conversion to full sternotomy or to extend the incision. Re-intervention to adjust the tightness of the band was required in 1 patient. There were 4 cases of mortality (8.6%). All four death cases had comorbidity and low birth weight (2500g or less). Limited upper mini-sternotomy is a technically feasible, safe, and effective approach that providing an adequately surgical view in closed heart surgery to reduce the invasiveness of the closed heart surgical repair via median sternotomy or thoracotomy approach.