Minimally invasive operation for congenital heart disease: a sex-differentiated approach.
OBJECTIVE
Since 1996, we have routinely used a minimally invasive sex-differentiated surgical approach for surgical repair of various simple congenital heart diseases, mostly including a right anterior minithoracotomy in female subjects and a midline ministernotomy in male subjects.


METHODS
Between August 1996 and December 2004, all patients who underwent a sex-differentiated surgical approach were included. Hospital results were compared with those of a group undergoing full sternotomy (control subjects). Patients' clinical conditions and satisfaction at follow-up were evaluated.


RESULTS
Three hundred eight patients underwent the sex-differentiated surgical approach: (1) minithoracotomy in 147 (47.7%) and (2) ministernotomy in 161 (52.3%). Thirty patients had a full sternotomy for atrial septal defect closure. The most common diagnosis was an atrial septal defect (231 [75%] patients). None of the patients required an extension of the surgical access. There were neither major complications nor hospital deaths. All patients were discharged home without residual defects. Median follow-up time was 71.5 months (range, 48.2-85.7 months). There were no late deaths. No scoliosis, asymmetric breast development, or lactation problems were reported in the minithoracotomy group. Twenty-five (17%) of 147 patients with minithoracotomies complained of a trivial, persistent (<6 months), sensitive skin deficit in the mammary area, most often localized at the inferomedial quadrant. The vast majority of patients (296 [96%] 308 patients) were in New York Heart Association class I, and 282 (91.5%) of 308 patients were satisfied with the cosmetic result of the operation.


CONCLUSIONS
The sex-differentiated surgical approach for simple congenital heart disease is a safe procedure, providing both excellent functional and cosmetic results. Anterolateral minithoracotomy is a valid and highly appreciated procedure in female patients.
Vida
Vladimiro L
VL
Pediatric and Congenital Cardiac Surgery Unit, University of Padua, Padua, Italy.
Padalino
Massimo A
MA
Boccuzzo
Giovanna
G
Veshti
Altin A
AA
Speggiorin
Simone
S
Falasco
Gianclaudio
G
Stellin
Giovanni
G
D000293:Adolescent; D000328:Adult; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006343:Heart Septal Defects / Q000601:surgery*; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D012727:Sex Characteristics; D013249:Sternum / Q000601:surgery; D013908:Thoracotomy / Q000379:methods; D055815:Young Adult