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eComment: Minimally invasive access for congenital heart disease repair

Adult Cardiac Surgery, ‘G. Pasquinucci’ Heart Hospital, Via Aurelia Sud, 54100 Massa, Italy;

Ministernotomy for repair of congenital cardiac disease

We read with a particular interest the article describing the application and place of a minimally invasive approach in the surgery of congenital pathology in small patients [1].

Since cardiac surgeons found themselves able to offer a less invasive access to the heart and great vessels, one of the first techniques to satisfy the tendency of minimizing surgical trauma during general cardiac surgical procedure was a ministernotomy coined by Gundry et al.[2].

Numerous variations of the ministernotomy approach have been proposed subsequently; however, it must be said that the characteristics of some of them make it more feasible and more easily adoptable than others [3].

Reading your report some questions arise. You are stating that some of the techniques may require expensive equipment that may raise the cost of some procedures. In our experience on adult patients, the expenses of a ministernotomy in the 3rd or 4th intercostal space are the same as the expenses of a complete median sternotomy, as long as percutaneous venous femoral cannulation, central cannulation with ultra-flexible aortic cannula, bendable X-clamp and sternal retractors specifically designed for minimally invasive procedures are not employed.

Whether this is a consecutive series and which selection criteria were employed is unclear. This report describes your experience in 79 patients. Were all patients at your department candidates for this approach, or did you elect to consider only the 79 patients within this work?

The age of the patient group in your report ranged from 1 month to 122 months with a median weight of 10.9 kg (3.5–40 kg). In view of the fact that the weight category is wide, it probably would be of particular interest to observe the length of incision with respect to the body surface area of the patients.

The chance of mammary artery injury due to the sternal retraction can definitely be considered as a major disadvantage of this approach. It would be interesting to know if you have encountered any internal mammary artery injury in your patient series.

Minimally invasive cardiac surgical procedures have increased in popularity in adult cardiac surgery in the recent years. These approaches have been applied to pediatric cardiac surgery in a limited fashion [1].

We would like to congratulate the authors of this paper for their excellent results and efforts in this matter.

	References

Top References

 

1. Sebastian VA, Guleserian KJ, Leonard SR, Forbess JM. Ministernotomy for repair of congenital cardiac disease. Interact CardioVasc Thorac Surg 2009;9:819–822.[Abstract/Free Full Text]
2. Gundry SR, Shattuck OH, Razzouk AJ, del Rio MJ, Sardari FF, Bailey LL. Facile minimally invasive cardiac surgery via ministernotomy. Ann Thorac Surg 1998;65:1100–1104.[Abstract/Free Full Text]
3. Karimov JH, Santarelli F, Murzi M, Glauber M. A technique of an upper V-type ministernotomy in the second intercostal space. Interact CardioVasc Thorac Surg, (in press).

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