Minimally access via left anterior mini-thoracotomy for repair of adult subarterial ventricular septal defects

BACKGROUND Minimally invasive cardiac surgical techniques are increasingly applied in the treatment and management of a variety of adult ventricular septal defects (VSDs). However, repair of adult subarterial VSDs via left anterior mini-thoracotomy is rarely reported. The present study aimed to determine the feasibility and safety of the left anterior mini-thoracotomy for the repair of adult subarterial VSDs. METHODS Twenty-seven adult patients underwent repair of subarterial VSDs via left anterior mini-thoracotomy. The approach includes two options for skin incision access, longitudinal and transverse skin incisions. The skin incision length was 4.1-6.1 cm (mean, 5.1 ± 0.6 cm). The closure of the VSDs was obtained through the main pulmonary artery under direct visualization. RESULTS Successful repair of the defects was achieved in all the patients. No patients died or converted to median sternotomy. Average durations of cardiopulmonary bypass (CPB) and aortic cross-clamp were 102.5 ± 13.6 min (range, 85-127 min) and 54.6 ± 6.9 min (range, 45-66 min), respectively. No patients required blood transfusion. The average postoperative hospital stay was 5.1 ± 0.7 days (range, 4-6 days). There were no postoperative complications related to the operative procedures or peripheral cannulation. During the follow-up of 5.4-32.3 months, no patients were found to have residual shunt, wound infections, pericardial effusion, neurologic or other complications. CONCLUSION Our experiences demonstrate that minimally invasive cardiac surgical technique via left anterior mini-thoracotomy can be served as a novel, feasible and safe alternative for the repair of adult subarterial VSDs.