title: The clinical pathway for fast track recovery of school activities in children after minimally invasive cardiac surgery.
abstract: BACKGROUND
  Minimally invasive cardiac surgery is now becoming standard in the correction of simple congenital cardiac malfbrmations. We introduced a clinical pathway for fast track recovery of school activities in children after minimally invasive cardiac surgery, and assessed the function of the pathway in children with atrial or ventricular septal defects, comparing minimally invasive surgery to repair through a conventional full sternotomy.
  
  
  METHODS
  We studied 15 children of school age who underwent repair of an atrial or ventricular septal defect through a lower midline sternotomy, and 10 children undergoing repair through a full sternotomy. The clinical pathway was for extubation to take place in the operating room, echocardiographic evaluation on the 5th postoperative day, and discharge home on the 7th postoperative day, with return to school within 2 weeks, and resumption of all gymnastic activity within 6 weeks of the minimally invasive surgery.
  
  
  RESULTS
  In those having a lower midline sternotomy, postoperative hospital stay was 7.4 +/- 0.8 days, with return to school 8.0 +/- 2.4 days after discharge. They resumed gymnastics 41 +/- 11 days after the minimally invasive surgery. In those having a full sternotomy, in contrast, these parameters were 13.5 +/- 2.7, 23.1 +/- 8.4, and 95 +/- 43 days, respectively. Of the 15 children undergoing a minimally invasive approach, 12 (80%) fulfilled the criterions of our clinical pathway.
  
  
  CONCLUSIONS
  We conclude that minimally invasive cardiac surgery can safely be performed in children. In addition to its cosmetic role, the technique has added value in promoting early return to normal school life, including gymnastics.
authors.affiliation: Division of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
authors.forename: Masamichi
authors.initials: M
authors.lastname: Ono
authors.forename: Norihide
authors.initials: N
authors.lastname: Fukushima
authors.forename: Shigeaki
authors.initials: S
authors.lastname: Ohtake
authors.forename: Hajime
authors.initials: H
authors.lastname: Ichikawa
authors.forename: Koji
authors.initials: K
authors.lastname: Kagisaki
authors.forename: Tohru
authors.initials: T
authors.lastname: Matsushita
authors.forename: Hikaru
authors.initials: H
authors.lastname: Matsuda
mesh_terms: D000293:Adolescent; D006348:Cardiac Surgical Procedures / Q000379:methods*; D016022:Case-Control Studies; D002648:Child; D015331:Cohort Studies; D005260:Female; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000601:surgery; D006344:Heart Septal Defects, Atrial / Q000175:diagnosis / Q000601:surgery*; D006345:Heart Septal Defects, Ventricular / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D011184:Postoperative Period; D020127:Recovery of Function; D012016:Reference Values; D012574:Schools; D012680:Sensitivity and Specificity; D013249:Sternum / Q000601:surgery; D013908:Thoracotomy / Q000379:methods; D013997:Time Factors