title: Minimal access surgery for the repair of simple congenital heart defects: factors affecting hospital stay after surgery.
abstract: OBJECTIVE
  We reviewed our experience of minimal access surgery to elucidate the efficacy and safety of this approach and determine the factors affecting hospital stay.
  
  
  METHODS
  Seventy-seven patients (age, 11.8 +/- 11.0 years), with body weight of more than 10 kg, were operated using various forms of minimal access approach for repair of simple congenital heart defects [atrial septal defect (ASD) in 40, ventricular septal defect in 37]. These included lower partial sternotomy (n = 68) and mini-thoracotomy (n = 9, ASD only) with limited skin incision of 4-11 cm. The anesthetic protocol was modified to wean all patients from ventilator soon after operation. The protocol of discharge from hospital (critical pass) was 14 days in the early period (n = 30) and 10 days in the late period (n = 47).
  
  
  RESULTS
  There were no hospital or late death, and no hospital re-admission. None of patients required blood transfusion. The endotracheal tube was extubated in the operating room in 48 cases (62%). Twenty-four patients (31%) failed to fulfill conditions of the critical pass. Univariate analysis of factors affecting unfavorably the critical pass demonstrated that the median approach, retention of pericardial effusion and social reasons were statistically significant, while an opened pleura and aortic cross-clamp time were marginally significant. Multivariate analysis indicated that the retention of pericardial effusion was the only significant factor that failed critical pass [p = 0.007, odds ratio (OR) 5.7, 95% confidence interval (CI) 1.61 -19.8]. In addition, a pericardio-pleural fenestration was the only significant factor that affected favorably the pericardial effusion (p = 0.035, OR 0.2, 95% CI 0.47-0.89) by multivariate analysis.
  
  
  CONCLUSIONS
  Our experience demonstrated that minimal access surgery of the simple congenital heart defects provided excellent cosmetic results. Retention of pericardial effusion, possibly due to pericarditis, was a major risk factor of the prolonged hospital stay. The pericardio-pleural fenestration could reduce the risk of retention of effusion.
authors.affiliation: Department of Cardiovascular Surgery, Hokkaido University Postgraduate School of Medicine, Kita-14, Nishi-5, Kita-ku, Sapporo 060-8648, Japan.
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Murashita
authors.forename: Eiichiro
authors.initials: E
authors.lastname: Hatta
authors.forename: Tomoyori
authors.initials: T
authors.lastname: Ooka
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Tachibana
authors.forename: Takehiro
authors.initials: T
authors.lastname: Kubota
authors.forename: Michihiko
authors.initials: M
authors.lastname: Ueno
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Murakami
authors.forename: Keishu
authors.initials: K
authors.lastname: Yasuda
mesh_terms: D000293:Adolescent; D000328:Adult; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D018709:Statistics, Nonparametric; D013249:Sternum / Q000601:surgery; D013908:Thoracotomy / Q000379:methods; D016896:Treatment Outcome