title: Short operation time: an important element to reduce operative invasiveness in pediatric cardiac surgery.
abstract: BACKGROUND
  The mini skin incision procedure is considered an important element of minimally invasive cardiac surgery because of its definitive cosmetic advantage. However, the operative hazard of limited exposure may be associated with prolonged operation time and increased surgical insult.
  
  
  METHODS
  A total of 357 consecutive patients undergoing repair of an isolated atrial or ventricular septal defect, in whom the mini skin procedure was applied, were investigated. Patients were grouped by diagnosis and body weight. Univariate and multivariate risk analyses were conducted in the specific patient group undergoing ventricular septal defect repair weighing less than 5 kg.
  
  
  RESULTS
  The operation time was reduced by 21.0% (93.4 to 73.8 minutes) during this time period. Univariate risk analysis revealed that the operation time had a significant correlation with time to extubation (p < 0.0001), catecholamine duration (p = 0.0003), intensive care unit stay (p < 0.0001), hospital stay (p = 0.016), arterio-alveolar oxygen tension difference at the time of extubation (p = 0.0253), and furosemide dose required in the first 24 hours (p = 0.0332). Multiple linear regression analysis revealed that the operation time had an impact on time to extubation, arterio-alveolar oxygen tension difference at the time of extubation, and intensive care unit stay. The length of skin incision was not correlated with any outcome measure.
  
  
  CONCLUSIONS
  The mini skin incision, if associated with prolonged operation time, may increase the overall insult in pediatric cardiac surgery. In order to reduce operative invasiveness, simultaneous effort to reduce, or at least not to increase, the operation time are mandatory.
authors.affiliation: Department of Pediatric Cardiac Surgery, Sakakibara Heart Institute, Tokyo, Japan. maando@shi.heart.or.jp
authors.forename: Makoto
authors.initials: M
authors.lastname: Ando
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Takahashi
authors.forename: Toshio
authors.initials: T
authors.lastname: Kikuchi
mesh_terms: D006348:Cardiac Surgical Procedures / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D006343:Heart Septal Defects / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D019060:Minimally Invasive Surgical Procedures / Q000706:statistics & numerical data; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome