Reducing the trauma of congenital heart surgery.

Techniques to reduce surgical trauma for congenital heart repairs continue to evolve in tandem with advances in the more conventional protection strategies. The concept of chest wall protection has been increasingly accepted as an important standard for congenital heart surgeons, as long as neuroprotection, myocardial protection, and operative precision are not adversely affected. Unfortunately, it is difficult to measure chest wall trauma, making it difficult to evaluate the efficacy of minimally invasive techniques. Efforts to reduce surgical trauma are advancing on multiple fronts. Many extracardiac repairs are being performed thoracoscopically, with excellent results. Intracardiac procedures can be performed through smaller incisions. Full sternotomy is giving way to a variety of sternal-sparing incisions for open-heart repairs, usually using direct visualization. Operative strategies to avoid or minimize the effects of cardiopulmonary bypass have emerged. And recently, hybrid procedures, utilizing a combination of transcatheter and minimally invasive techniques, are creating new therapeutic options for the congenital heart team.