Minimally Invasive Congenital Cardiac Surgery: A Large Volume European Experience

Background: In an effort to reduce postoperative trauma and achieve more cosmetic results, minimally invasive approaches to correct congenital heart anomalies have been recently proposed and increasingly adopted. Here we describe our experience for the past 23 years. Methods: Patients who underwent a surgical procedure between February 1996 and March 2019 with a minimally invasive approach for the correction of congenital heart disease in our center were included in this study. A statistical analysis was carried out to compare the results of the different minimally invasive techniques. A meta-analysis was conducted to compare our results in patients undergoing atrial septal defect repair with those from other groups. Results: There were 1002 patients included. A midline lower mini-sternotomy was performed in 45% of patients (n = 455), a right anterior mini-thoracotomy in 36% (n = 356) and a right lateral mini-thoracotomy in 19% (n = 191). The procedures were atrial septal defect repair (n = 575, 57%), ventricular septal defect repair (n = 218, 22%), and correction of atrioventricular defect (n = 82, 8%) or partial anomalous pulmonary venous return (n = 70, 7%). Post-cardiotomy syndrome was the most frequent complication (n = 40, 4%). No difference was observed between the approaches in terms of complications and peri-operative outcomes, and when these were compared with the results of other centers. Conclusions: Patients undergoing surgical repair of congenital heart disease through a minimally invasive approach have excellent outcomes, regardless of the approach used.