Minimally Invasive Surgery for Simple Congenital Heart Defects Preserving Aesthetics without Jeopardizing Patient Safety

Lo Rito M, Brindicci YCM, Moscatiello M, Varrica A, Reali M, Saracino A, Chessa M, Aloisio T, Isgrò G, Giamberti A. Minimally Invasive Surgery for Simple Congenital Heart Defects: Preserving Aesthetics without Jeopardizing Patient Safety. J Cardiovasc Dev Dis. 2023 Nov 6;10(11):452. doi: 10.3390/jcdd10110452. PMID: 37998510; PMCID: PMC10672407. Abstract Minimally invasive surgeries for pediatric patients have been proposed for decades, with different approaches in mind. Minimal right axillary thoracotomy (MRAT), proposed two decades ago, allows the preservation of patients' safety alongside faster aesthetic and functional recovery. The MRAT did not become widely adopted due to the prejudice that to follow a minimally invasive approach, safety and efficacy must be compromised. With this study, we aim to compare MRAT to the standard median sternotomy approach with a focus on safety and clinical outcomes. Between January 2017 and April 2021, 216 patients diagnosed with ASD, pAVSD, or PAPVD underwent surgical repair with different approaches in the same period. MRAT was used for 78 patients, and median sternotomy was used for 138 patients. In this last group, standard median sternotomy (SMS) was used for 116 patients, while a minimal skin incision (SMS mini) was used for 22 patients. There were no major complications overall nor in each specific approach. MRAT enabled the successful repair of simple heart defects, providing similar post-operative and cardiological recovery. MRAT does not compromise patients' safety and does not prolong the duration of surgery once the learning curve is overcome, which is generally after 15-20 consecutive operations.Lo Rito M、Brindicci YCM、Moscatiello M、Varrica A、Reali M、Saracino A、Chessa M、Aloisio T、Isgrò G、Giamberti A. 《微创外科治疗单纯性先天性心脏病：在不危及患者安全的前提下兼顾美学效果》。*J Cardiovasc Dev Dis*. 2023年11月6日；10(11)：452。DOI: 10.3390/jcdd10110452；PMID: 37998510；PMCID: PMC10672407。 摘要 针对儿科患者的微创外科（Minimally Invasive Surgery）技术已被提出数十年，学界探索了多种术式路径。二十年前问世的右腋下微创胸壁切开术（Minimal Right Axillary Thoracotomy, MRAT），可在保障患者安全的同时，实现更快的美学与功能恢复。但由于此前存在“采用微创术式必然牺牲安全性与有效性”的认知偏见，MRAT并未得到广泛推广。本研究旨在对比MRAT与标准正中胸骨切开术的临床效果，重点关注其安全性与临床转归。 2017年1月至2021年4月期间，共计216名被诊断为房间隔缺损（Atrial Septal Defect, ASD）、部分型房室间隔缺损（partial Atrioventricular Septal Defect, pAVSD）或部分性肺静脉异位引流（Partial Anomalous Pulmonary Venous Drainage, PAPVD）的患者，在同一时期接受了不同术式的外科修复手术。其中78例采用MRAT，138例采用正中胸骨切开术：后者包含116例标准正中胸骨切开术（standard median sternotomy, SMS）及22例极小皮肤切口术式（SMS mini）。 研究结果显示，所有受试者及各术式亚组均未出现重大并发症。MRAT可成功完成单纯性心脏缺损的修复手术，术后恢复情况与心脏相关转归与传统术式相当。在克服通常为15~20例连续手术的学习曲线后，采用MRAT既不会危及患者安全，亦不会延长手术时长。