title: The limiting factors for the transxiphoid approach in congenital cardiac surgery.
abstract: OBJECTIVE
  Minimally invasive cardiac surgery is currently being performed for a wide variety of cardiothoracic procedures. Since August 1998, the transxiphoid approach using a direct cannulation to the ascending aorta has been selected for the closure of atrial septal defects (ASD) and ventricular septal defects (VSD) in our institution. However, this approach cannot be performed for all patients because of the small "xiphoid window." We analyzed the factors limiting this approach to determine the best factor predicting risk.
  
  
  METHODS
  Of 26 patients who had an ASD or a VSD, 14 underwent complete repair using a transxiphoid approach. Preoperative data collected for all patients included the relationship between the right ventricular outflow tract and the lower sternum (the RVSA) in the cineangiograph. Multiple logistic regression analysis was used to investigate which of the factors best predicted whether the transxiphoid approach should be adopted.
  
  
  RESULTS
  The factors best predicting this approach were the combination of RVSA and body surface area (BSA) (odds ratios of 2.982 [P = .018] and 0.925 [P = .046], respectively). With the logistic model used in a prospective study of 6 consecutive patients, we were completely successful in predicting whether the transxiphoid approach could be performed.
  
  
  CONCLUSIONS
  The combination of RVSA and BSA was the limiting factor for using the transxiphoid approach in congenital cardiac surgery.
authors.affiliation: Department of Cardiothoracic Surgery, University of Tokyo Hospital, Tokyo, Japan. kagami111@aol.com
authors.forename: Kagami
authors.initials: K
authors.lastname: Miyaji
authors.forename: Arata
authors.initials: A
authors.lastname: Murakami
authors.forename: Hajime
authors.initials: H
authors.lastname: Sato
authors.forename: Shinichi
authors.initials: S
authors.lastname: Takamoto
mesh_terms: D006348:Cardiac Surgical Procedures / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000601:surgery*; D006345:Heart Septal Defects, Ventricular / Q000601:surgery*; D006801:Humans; D008297:Male; D016896:Treatment Outcome; D014989:Xiphoid Bone / Q000601:surgery*