Less Invasive Cardiac Surgery

PURPOSE
Recently, less invasive or minimally invasive procedures have gained increasing popularity in cardiac surgery. Applications of the se techniq ues on diffe rent pathologies should be investigated. Materials and
METHODS
Between April 1997 to March 1998, open heart surgery was performed in 2 I patients via a right anteri or submammarian minithoracotomy incision. Procedures were: Atrial septal defect (n=6); partial anomalous pulmonary venous returo (PAPVR) (n=2); ventricular septal defect and mitral cleft (n=2); partial atrioventricular şeptal defect (n=l); aortic commissurotomy (n=3); aortic valve replacement and subaortic stenosis (n=2); subaortic s te nosis (n=3); mi tral commissurotomy (n=2). A right submammary skin incision w as m ade. It runs from 1 - 1,5 cm lateral to the sternal edge and extends to anterior axillary line. The thorax was opened through the third intercostal space for aortic valve procedures and through the fourth intercostal space for others. Incision length ranged from 7 to 10 cm in 10 patients and 10 to 12 cm in l l patients. Cardiopulmonary bypass was connected through the thoracotomy incis ion . Standard surgical technique and equipment were employed dur ing the procedures. The mean age of the patients w as 17.4 years (ran ge 3 to 7 5 years) and mean weight was 32,7±16.5 kg (range 13 to 60 kg). The mean cardiopulmonary bypass and cross-clamp time was 77.9±54 min and 46±34 min respectively. Right internal thoracic artery was preserved in 13 patients.
RESULTS
There was no mortaJi ty. To obtain adequate exposure, we had to make transverse sternotomy in one patient who had atypical PAPVR. Patients could be extubated at an average of s tay 1 0.2±4.4 hours postoperatively. The intensive care stay was 1.5 days and hospital stay 6 days (5.8±3 days).
CONCLUSION
This method was safe and effective for aortic and mitral valve operations and for some congenital operations which may be done via right atrial approach. This method may be preferred because of patient's psychology and cosmetic causes.