Minimally invasive surgery with cardioscopy for congenital heart defects

Background. Minimally invasive cardiac surgery remains a burgeoning discipline lacking adequate instrumentation and perfusion circuitry, particularly for the pediatric population. Cardioscopy, utilizing first generation imaging equipment with a variety of different angled lenses, provides a unique opportunity to expand the realm for the diagnosis and treatment of congenital heart disease. Methods. Sixty-eight children with a mean weight of 23 ± 11 kg (range 8–62 kg) who underwent repair of atrial septal defects (ASD) using a minimally invasive approach (MINI group) were compared to 25 consecutive children undergoing ASD repair via a full median sternotomy (CONT group). In addition, mini-sternotomy with or without cardioscopy allowed for the diagnosis and treatment of more complex congenital lesions in 24 children. Results. The mean age in the MINI group was 7 ± 3 years (range 1–15 years) compared to 4 ± 4 years in the CONT group (p = 0.009). The mean body surface area of the MINI group (0.8 ± 0.2 m2; range 0.4–1.6 m2) was larger than the CONT group (mean 0.6 ± 0.3 m2; range 0.2–1.6 m2; p = 0.04). Ischemic times and cardiopulmonary bypass times were similar in both groups. Postoperative hospital stay was shorter in the MINI group (3 ± 2 versus 4 ± 1 days; p = 0.014). Conclusions. Minimally invasive cardiac surgery can be performed safely even in small children with congenital heart defects. In addition to improved cosmetic results, these techniques can reduce the utilization of hospital resources. Future advances in cardioscopic technology should permit minimally invasive repair of most complex congenital heart lesions and should obviate the need for full sternotomy in the majority of children undergoing cardiac surgery.