[III-JCKAP6-2-4] Peri-Areolar Approach for Minimally Invasive Closure of Type 1 Ventricular Septal Defect
Keywords:Minimally invasive cardiac surgery, type 1 ventricular septal defect, peri-areolar incision
Objective: Type 1 or outlet ventricular septal defects(VSD) are challenging to visualize through a right thoracotomy, and many centers still use sternotomy for repair. We present a minimally invasive approach combining a peri-areolar incision and left anterior thoracotomy for repairing type 1 VSD in adult patients.
Methods: In a supine position, a three-centimeter incision is made along the cranio-medial border of the left areolar. The subcutaneous fat layer is carefully dissected towards the second intercostal space. Access to the pericardial space can be achieved through a mini-thoracotomy at the second intercostal space. Cardiopulmonary bypass is initiated via peripheral cannulation, and the aorta is clamped with a Chitwood clamp introduced through a separate port in the axillary area. After the heart is stopped, an incision at the main pulmonary artery provides a clear view of the right ventricle outflow tract(RVOT) and the VSD.
Results: Three female and one male patients underwent minimally invasive VSD closure at a median age of 31 years [range 18-56]. Cardiopulmonary bypass and aorta cross-clamp time were at a median of 129 [range 114-170] and 69 [range 54-151] minutes, respectively. Everyone was extubated the same day and discharged after a median of 4 days [range 4-7].
Conclusion: A minimally invasive approach combining a peri-areolar incision and left anterior thoracotomy provides fast recovery and superior cosmetic results for the repair of type 1 VSDs or simple RVOT procedures in adult patients.
Methods: In a supine position, a three-centimeter incision is made along the cranio-medial border of the left areolar. The subcutaneous fat layer is carefully dissected towards the second intercostal space. Access to the pericardial space can be achieved through a mini-thoracotomy at the second intercostal space. Cardiopulmonary bypass is initiated via peripheral cannulation, and the aorta is clamped with a Chitwood clamp introduced through a separate port in the axillary area. After the heart is stopped, an incision at the main pulmonary artery provides a clear view of the right ventricle outflow tract(RVOT) and the VSD.
Results: Three female and one male patients underwent minimally invasive VSD closure at a median age of 31 years [range 18-56]. Cardiopulmonary bypass and aorta cross-clamp time were at a median of 129 [range 114-170] and 69 [range 54-151] minutes, respectively. Everyone was extubated the same day and discharged after a median of 4 days [range 4-7].
Conclusion: A minimally invasive approach combining a peri-areolar incision and left anterior thoracotomy provides fast recovery and superior cosmetic results for the repair of type 1 VSDs or simple RVOT procedures in adult patients.