Lower Sternotomy Access for Congenital Heart Surgery

(#2001-6830 ... June 27, 2001)

Jeong Ryul Lee, MD, Ji Min Chang, MD, Cheong Lim, MD, Cheul Lee, MD, Yong Jin Kim, MD, Joon Ryang Rho, MD

Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul National University Clinical Research Institute, Seoul, Korea

Presented at the Fourth Annual Scientific Meeting of the International Society for Minimally Invasive Cardiac Surgery, June 27-30, 2001, Munich, Germany.

ABSTRACT

Background: Minimally invasive cardiac surgery recently has been applied in the management of a variety of cardiac lesions. As our experiences accumulated, we were able to expand the minimal access approach to the repair of more complex congenital heart lesions.

Methods: From July 1997 to December 2000, 494 patients with congenital heart disease underwent T or J-shaped lower sternotomy by thoracic entry. Cardiac diagnosis consisted of ventricular septal defect(n=322), atrial septal defect(n=118), and more complex anomalies(n=54). The approach consisted of a 4-10cm cephalad skin incision starting from the costoxyphoid angle, minimal dissection of the peristernal tissues, T or J lower sternotomy and a sternal opening using a self-retraction system of our own design. Conventional direct aortic and bicaval cannulation were used.

Results: Mean length of the skin incision was 6.2 ±1.4 (range: 4.0-10) cm. Mean distance between the suprasternal notch and the upper most point of the skin incision was 4.4 ±1.2 (range: 3.4-9.5) cm. All the patients showed an uneventful postoperative course. The mean total amount of analgesics used was 0.37±0.98 mg of morphine. The mean duration of hospitalization after operation was 5.2 ±5.0 days, and there were no wound complications or hospital deaths.

Conclusions: We found that the application of the minimal access technique by lower sternotomy on a selected group of congenital heart disease patients was feasible and more attractive in terms of cosmetic outcome. Our simple sternal opening method is both useful and effective.