Minimally Invasive Cardiac Surgery Without Peripheral Cannulation: A Single Centre Experience

Abstract

A minimally invasive approach without any peripheral cannulation was used as an alternative to median sternotomy for the correction of a wide range of cardiac defects with superior results and good cosmetic outcome. From October 2015 to March 2017, 145 patients underwent correction of congenital cardiac malformations with cardiopulmonary bypass through right anterior minithoracotomy (RAMT) with routine cannulation. The average age was 9.69±4.38years (range 2-21) and the average body surface area was 0.91±0.27square metres (range 0.5-1.7). The corrected defects included all types of atrial septal defect (ASD) and ventricular septal defects (VSD), partial atrioventricular septal defects with severe mitral regurgitation, mitral valve repair, repair of tetralogy physiology requiring outlet patch enhancement, isolated pulmonary stenosis (PS) and congenital coronary cameral fistula. There was no operative mortality or major morbidity. All patients were alive at the time of this follow-up. The mean cardiopulmonary bypass time was 64.75±22.28minutes (range 30-175) and mean aortic cross clamp time was 37.53±18.23minutes (range 14-135). Fifty-five (55) patients were extubated in the operating room and the remaining 90 patients were extubated within 3hours in the intensive care unit. Repair and cosmetic results were excellent in all patients. There were no conversions to full sternotomy. No neurological events were reported. Right anterior minithoracotomy without peripheral cannulation is safe and effective for the correction of a wide range of congenital heart defects including right ventricular outlet obstructions. The cosmetic results are satisfactory, avoiding psychosocial problems.