The Journal of thoracic and cardiovascular surgery · 2025
Single incision minimally invasive congenital heart surgery: Insights into program development and outcome.
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Haller Christoph, Karunasumetta Chananya, Zubair Areeba, Russell Jennifer, Taylor Katherine L, Honjo Osami, Barron David J
Аннотация
OBJECTIVES: To provide insight into program development, procedural efficacy, and expansion to higher-complexity lesions in a single-center experience with an inception cohort of minimally invasive congenital heart surgery (MICS) patients.
METHODS: All patients undergoing MICS procedures between April 2018 and August 2024 at our institution were included. MICS was performed through a single right vertical mini-thoracotomy. Most cases were performed with central cannulation. We recorded demographic data, lesion and procedure type, intraoperative details, and common outcome parameters. Low-risk patients were eligible for a return-to-ward pathway with a 4-hour observation period in the intensive care unit.
RESULTS: A total of 232 MICS patients were included in our analysis. The most common lesions were secundum atrial septal defect (50.0%), partial anomalous pulmonary venous drainage/sinus venosus defect (21.1%), partial atrioventricular septal defect (AVSD; 13.8%), and ventricular septal defect (9.1%). More complex congenital heart diseases included complete AVSD, mitral valve repair, endocarditis, and single ventricle lesions. Simple defects were increasingly repaired by MICS (30.4% in the first year vs 82.1% in the final year). Surgical procedural times were significantly longer in the first half of the study period compared to the second half (P < .005). Procedural times in the last year were shorter by 23.1% compared to the first year of our experience, despite increasing complexity and a wider patient spectrum.
CONCLUSIONS: MICS can be performed safely for a wide variety of lesions. Building an MICS program is associated with a steep learning curve but can be achieved with high efficiency and patient satisfaction.
METHODS: All patients undergoing MICS procedures between April 2018 and August 2024 at our institution were included. MICS was performed through a single right vertical mini-thoracotomy. Most cases were performed with central cannulation. We recorded demographic data, lesion and procedure type, intraoperative details, and common outcome parameters. Low-risk patients were eligible for a return-to-ward pathway with a 4-hour observation period in the intensive care unit.
RESULTS: A total of 232 MICS patients were included in our analysis. The most common lesions were secundum atrial septal defect (50.0%), partial anomalous pulmonary venous drainage/sinus venosus defect (21.1%), partial atrioventricular septal defect (AVSD; 13.8%), and ventricular septal defect (9.1%). More complex congenital heart diseases included complete AVSD, mitral valve repair, endocarditis, and single ventricle lesions. Simple defects were increasingly repaired by MICS (30.4% in the first year vs 82.1% in the final year). Surgical procedural times were significantly longer in the first half of the study period compared to the second half (P < .005). Procedural times in the last year were shorter by 23.1% compared to the first year of our experience, despite increasing complexity and a wider patient spectrum.
CONCLUSIONS: MICS can be performed safely for a wide variety of lesions. Building an MICS program is associated with a steep learning curve but can be achieved with high efficiency and patient satisfaction.