Thoracoscopic closure of ventricular septal defect in young children: technical challenges and solutions

To investigate the feasibility and safety of totally thoracoscopic repair of ventricular septal defects (VSDs) in young children. VSD repair was conducted in 36 children (21 boys, mean age 2.5 +/- 1.7 years, range 2-5, mean body weight 17.4 +/- 2.1 kg) by a totally thoracoscopic approach. Cardiopulmonary bypass (CPB) was achieved peripherally. Through three port incisions in the right chest wall, pericardiotomy, atriotomy and VSD repair were performed under the direct view of a thoracoscopy. Forty patients who were treated with a traditional VSD closure through a sternotomy were selected as a control group. There was no statistically significant difference in age, sex or types of VSD between the study and control group (P > 0.05). In the study group, CPB was established through femoral vessels in 28 (77.8%) patients, and through both the right internal jugular vein and the femoral vessels in eight (22.2%). The aortic cross-clamp time (32 +/- 6 vs 29 +/- 3 min, P = 0.06) and CPB time (46 +/- 11 vs 48 +/- 4 min, P = 0.107) were similar between the study and control groups. However, the total operation time, mechanical ventilation time, intensive care stay and overall hospital stay in the study group were shorter than in the control group (P < 0.05). Transthoracic echocardiography 3 months after the operation showed no residual shunt in the ventricular septum. Thoracoscopic closure of VSDs in young children appears feasible and safe.