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  • Review Article
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Minimally invasive paediatric cardiac surgery

Nature Reviews Cardiology volume 11, pages 24–34 (2014)Cite this article

Subjects

Key Points

  • Minimally invasive surgery for congenital heart disease in paediatric patients is a broad concept; the aim is to reduce the trauma of the operation at each stage of management

  • Minimally invasive incisions produce better cosmetic results, and reduce rehabilitation time and pain when compared with traditional open heart surgery

  • Minimally invasive incisions and cardiopulmonary bypass strategies, video-assisted thoracoscopic surgery, robotically assisted surgery, hybrid procedures, and image-guided intracardiac surgery have been developed

  • Improvement of these minimally invasive strategies relies on the development of new devices, real-time multimodality imaging, and aids to instrument navigation

  • Reducing global trauma and morbidity related to surgery requires a multidisciplinary co-ordinated approach involving congenital cardiac surgeons, perfusionists, anaesthesiologists, intensivists, cardiologists, and nurses

  • The goal of the team dedicated to minimally invasive paediatric cardiac surgery is to go beyond technological and medical limitations to 'treat more while hurting less'

Abstract

The concept of minimally invasive surgery for congenital heart disease in paediatric patients is broad, and has the aim of reducing the trauma of the operation at each stage of management. Firstly, in the operating room using minimally invasive incisions, video-assisted thoracoscopic and robotically assisted surgery, hybrid procedures, image-guided intracardiac surgery, and minimally invasive cardiopulmonary bypass strategies. Secondly, in the intensive-care unit with neuroprotection and 'fast-tracking' strategies that involve early extubation, early hospital discharge, and less exposure to transfused blood products. Thirdly, during postoperative mid-term and long-term follow-up by providing the children and their families with adequate support after hospital discharge. Improvement of these strategies relies on the development of new devices, real-time multimodality imaging, aids to instrument navigation, miniaturized and specialized instrumentation, robotic technology, and computer-assisted modelling of flow dynamics and tissue mechanics. In addition, dedicated multidisciplinary co-ordinated teams involving congenital cardiac surgeons, perfusionists, intensivists, anaesthesiologists, cardiologists, nurses, psychologists, and counsellors are needed before, during, and after surgery to go beyond apparent technological and medical limitations with the goal to 'treat more while hurting less'.

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Figure 1: The lower partial (or 'mini') sternotomy.
Figure 2: A right submammary incision (also called right anterolateral thoracotomy).
Figure 3
Figure 4: Video-assisted thoracoscopic surgery.
Figure 5: The hybrid stage I procedure for hypoplastic left heart syndrome.
Figure 6: Development of retrograde coarctation (white arrow) in a 3-month-old patient after a hybrid stage I procedure.
Figure 7
Figure 8: Perventricular closure of a complex mid-muscular ventricular septal defect.

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Authors and Affiliations

  1. Department of Paediatric and Congenital Cardiac Surgery, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Centre, 3959 Broadway, New York, 10032, NY, USA

    Emile Bacha & David Kalfa

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  1. Emile Bacha
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  2. David Kalfa
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Both authors researched data for the article, contributed to the discussion of content, wrote the manuscript, and reviewed/edited the article before submission.

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Correspondence to Emile Bacha.

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The authors declare no competing financial interests.

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Bacha, E., Kalfa, D. Minimally invasive paediatric cardiac surgery. Nat Rev Cardiol 11, 24–34 (2014). https://doi.org/10.1038/nrcardio.2013.168

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