Anterolateral minithoracotomy versus median sternotomy for the treatment of congenital heart defects: a meta-analysis and systematic review

Journal of Cardiothoracic Surgery

Zhonghua Shen¹  Kaiyu Tao¹  Daming Jiang¹  Minjian Kong¹  Aiqiang Dong¹  Chunmao Wang¹  Chao Ding¹ 

[1] Department of Cardiothoracic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, PR China

关键词: Congenital heart defect;    Sternotomy;    Minimally invasive surgical procedures;   

Others  :  1153266
DOI  :  10.1186/1749-8090-7-43

 received in 2011-12-14, accepted in 2012-04-16,  发布年份 2012

【 摘 要 】

Background

Anterolateral Minithoracotomy (ALMT) for the radical correction of Congenital Heart Defects is an alternative to Median Sternotomy (MS) due to reduce operative trauma accelerating recovery and yield a better cosmetic outcome after surgery. Our purpose is to conduct whether ALMT would bring more short-term benefits to patients than conventional Median Sternotomy by using a meta-analysis of case–control study in the published English Journal.

Methods

6 case control studies published in English from 1997 to 2011 were identified and synthesized to compare the short-term postoperative outcomes between ALMT and MS. These outcomes were cardiopulmonary bypass time, aortic cross-clamp time, intubation time, intensive care unit stay time, and postoperative hospital stay time.

Results

ALMT had significantly longer cardiopulmonary bypass times (8.00 min more, 95% CI 0.36 to 15.64 min, p = 0.04). Some evidence proved that aortic cross-clamp time of ALMT was longer, yet not significantly (2.38 min more, 95% CI −0.15 to 4.91 min, p = 0.06). In addition, ALMT had significantly shorter intubation time (1.66 hrs less, 95% CI −3.05 to −0.27 hrs, p = 0.02). Postoperative hospital stay time was significantly shorter with ALMT (1.52 days less, 95% CI −2.71 to −0.33 days, p = 0.01). Some evidence suggested a reduction in ICU stay time in the ALMT group. However, this did not prove to be statistically significant (0.88 days less, 95% CI −0.81 to 0.04 days, p = 0.08).

Conclusion

ALMT can bring more benefits to patients with Congenital Heart Defects by reducing intubation time and postoperative hospital stay time, though ALMT has longer CPB time and aortic cross-clamp time.

【 授权许可】

   
2012 Ding et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1 .

Figure 2 .

Figure 3 .

Figure 4 .

Figure 5 .

Figure 6 .

【 参考文献 】

• [1]Bari M, John RP, Rex DS, Catherine J, Christopher R, Ara D, Thanos A: Minimal access aortic valve replacement: is it worth it? Ann Thorac Surg 2008, 85:1121-31.
• [2]Gaetano P, Raffaele G, Veronica R, Sabato C, Sergio P, Marco M, Vincenzo P, Giuseppina L, Carlo V: Anterolateral Minithoracotomies for the Radical Correction of Congenital Heart Defects. Tex Heart Inst J 2009, 36(6):575-579.
• [3]Lin PJ, Chang CH, Chu JJ, Liu HP, Tsai FC, Chung YY, Kung CC, Lin FC, Chiang CW, Su WJ, Yang MW, Peter PT: Surgical closure of Atrial Septal Defect minimally invasive cardiac surgery or Median Sternotomy? Surg Endosc 1997, 12:820-824.
• [4]Jung SH, Je HG, Choo SJ, Yun TJ, Chung CH, Lee JW: Right or left Anterolateral Minithoracotomy for repair of congenital Ventricular Septal Defects in adult patients. Interact Cardiovasc Thorac Surg 2010, 10:22-26.
• [5]Virgilijus T, Virgilijus L, Vytautas S: Surgical alternative – the closure of heart Septal Defects via less invasive approaches. Semin Cardiovasc Med 2009, 15(3):1-6.
• [6]Murat B, Ali K, Cihan O, Alper U, Eylul K, Melih U: Comparison of 3 Different Incisions Used for Atrial-Septal Defect Closure. Heart Surg Forum 2008, 11(5):290-294.
• [7]Qiao CH, Yan BJ, Zhang X, Zhao GF, Zhang WH, Shi CP: Comparative study of right Anterolateral Minithoracotomy and Median Sternotomy in the repair of Atrial Septal Defects. Di Yi Jun Yi Da Xue Xue Bao 2003, 23(9):956-960.
• [8]Vladimiro LV, Massimo AP, Giovanna B, Altin AV, Simone S, Gianclaudio F, Giovanni S: Minimally invasive operation for Congenital Heart Defect: A sex-differentiated approach. J Thorac Cardiovasc Surg 2009, 138(4):933-936.
• [9]Nicolas D, Thomas W, Volkmar F, Christian B, Jan B, Michael AB, Jan FG, Friedrich WM, Martin K: Secundum ASD Closure Using a Right Lateral Minithoracotomy: Five-Year Experience in 122 Patients. Ann Thorac Surg 2003, 75:1527-1530.
• [10]Thomas W, Christian B, Ardawan R, Ingo D, Nicolas D, Volkmar F, Friedrich WM, Martin K: Surgical Atrial Septal Defect closure after interventional occluder placement: Incidence and outcome. J Thorac Cardiovasc Surg 2007, 134:731-7.
• [11]Gerhard WG, Selami D, Tayfun A, Mohammad FK, Stephan M, Christian B, Anton M: Totally endoscopic atrial septal repair in adults with computer-enhanced telemanipulation. J Thorac Cardiovasc Surg 2003, 126:465-8.
• [12]Miguel BM, Carla T, Marcelo BJ, Edmar A, Adib DJ: Transxiphoid Approach without Median Sternotomy for the Repair of Atrial Septal Defects. Ann Thorac Surg 1998, 65:771-774.
• [13]Lin PJ, Chang CH, Chu JJ, Liu HP, Tsai FC, Su WJ, Yang MW, Peter PC: Minimally Invasive Cardiac Surgical Techniques in the Closure of Ventricular Septal Defect: An Alternative Approach. Ann Thorac Surg 1998, 65:165-169.
• [14]Guo QK, Lu ZQ, Cheng SF, Cao Y, Zhao YH, Zhang C, Zhang YL: Off-pump occlusion of trans-thoracic minimal invasive surgery (OPOTTMIS) on simple Congenital Heart Defects (ASD, VSD and PDA) attached consecutive 210 cases report: A single institute experience. J Cardiothorac Surg 2011, 6(48):1-9.
• [15]Ulf AR, Gerhard WG, Georg M, Armin K, Uwe S, Roland H, Anton M: Correction of simple Congenital Heart Defects in infants and children through a minithoracotomy. Ann Thorac Surg 2001, 72(5):1645-1649.
• [16]Beşoğul Y, Ozcan V, Yavuz T, Tünerir B, Aslan R: Experiments on minimally invasive open heart surgery using right Anterolateral Minithoracotomy. Anadolu Kardiyol Derg 2002, 2(4):309-12.
• [17]Liu YL, Zhang HJ, Sun HS, Li SJ, Yan J, Su JW, Yu CT: Repair of cardiac defects through a shorter right lateral thoracotomy in children. Ann Thorac Surg 2000, 70(3):738-41.
• [18]Marcelo GA, Manuel H, Axel H, Roswitha S, Detlev MA, Thea K: One-Lung Ventilation with High Tidal Volumes and Zero Positive End-Expiratory Pressure Is Injurious in the Isolated Rabbit Lung Model. Anesth Analg 2003, 96:220-8.
• [19]Gothard J: Lung injury after thoracic surgery and one-lung ventilation. Curr Opin Anesthesiol 2006, 19(1):5-10.
• [20]Carmen U, Ignacio C, Victoria M: Pressure-Controlled Versus Volume-Controlled Ventilation during One-Lung Ventilation for Thoracic Surgery. Anesth Analg 2007, 104(5):1029-1033.
• [21]David M, Probal G, Sergey P: Minimally Invasive Congenital Cardiac Surgery Through Right Anterior Minithoracotomy Approach. Ann Thorac Surg 2008, 85(3):831-835.
• [22]Khoshbin E, Prayaga S, Kinsella J, Sutherland FWH: Mini-sternotomy for aortic valve replacement reduces the length of stay in the cardiac intensive care unit: meta-analysis of randomized controlled trials. BMJ Open 2011, 1:e000266.
• [23]Morgan LB, Stephen HM, Thoralf MS, Hartzell VS: Ministernotomy versus conventional sternotomy for aortic valve replacement: a systematic review and meta-analysis. J Thorac Cardiovasc Surg 2009, 137:670-9.e5.