title: Lower mini-sternotomy in congenital heart disease: just a cosmetic improvement?
abstract: OBJECTIVE
  Lower mini-sternotomy represents a minimally invasive surgical technique that has been utilized for the repair of a wide variety of congenital heart defects with excellent surgical and cosmetic outcomes. However, clinical improvements provided for this technique beyond cosmetic results are controversial. The aim of our study is to report our results with lower mini-sternotomy for the repair of congenital heart malformations and compare them with a matched group with a full median sternotomy approach.
  
  
  METHODS
  From 2010 through 2013, 105 consecutive congenital patients (81 paediatric) underwent lower mini-sternotomy at our centre (Group 1). We analysed in-hospital and follow-up outcomes, and compare them with an age-sex-diagnosis-type of surgery-matched group (Group 2). Both groups were managed following the same clinical protocols.
  
  
  RESULTS
  In Group 1, age at the time of surgery was 12 ± 17 years (range from 0.2 to 64.6 years). In this group, 81 patients were paediatric and 62 were female. Operative techniques were atrial septal defect (n = 72), ventricular septal defect (n = 24) and atrioventricular canal repairs (n = 9). There were no deaths or major in-hospital complications. Two adult patients required conversion to full median sternotomy. For a medium follow-up of 1.5 years (range from 1 month to 5 years), there were no deaths, reinterventions or reoperations and no significant residual defects were found. Compared with Group 2, patients in Group 1 had longer cardiopulmonary bypass times (58.71 ± 19.08 vs 45.39 ± 20.45, P < 0.001) and cross-clamp times (32.75 ± 13.11 vs 23.22 ± 13.93, P < 0.001), higher rate of early extubation (96 vs 85%, P = 0.018) and lower rate of postoperative complications (11.6 vs 22.3%, P = 0.034).
  
  
  CONCLUSIONS
  At our centre, lower mini-sternotomy represents a safe alternative for the repair of congenital heart defects in paediatric and adult populations. Cardiopulmonary bypass and cross-clamp times were longer in the mini-sternotomy group. However, these patients showed earlier extubation and less postoperative complications when compared with patients with a full sternotomy approach. Combined with improved cosmetic outcomes, lower mini-sternotomy could represent the technique of choice for these populations.
authors.affiliation: Department of Cardiovascular Surgery, Instituto de Investigación Biomédica (Cardiopatía Estructural y Congénita) y Complexo Hospitalario Universitario A Coruña, Spain.
authors.forename: Maria
authors.initials: M
authors.lastname: Garcia Vieites
authors.affiliation: Department of Pediatric Cardiology, Instituto de Investigación Biomédica (Cardiopatía Estructural y Congénita) y Complexo Hospitalario Universitario A Coruña, Spain.
authors.forename: Ivonne
authors.initials: I
authors.lastname: Cardenas
authors.affiliation: Department of Cardiovascular Surgery, Instituto de Investigación Biomédica (Cardiopatía Estructural y Congénita) y Complexo Hospitalario Universitario A Coruña, Spain.
authors.forename: Hugo
authors.initials: H
authors.lastname: Loyola
authors.affiliation: Department of Cardiovascular Surgery, Instituto de Investigación Biomédica (Cardiopatía Estructural y Congénita) y Complexo Hospitalario Universitario A Coruña, Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Fernandez Arias
authors.affiliation: Department of Pediatric Cardiology, Instituto de Investigación Biomédica (Cardiopatía Estructural y Congénita) y Complexo Hospitalario Universitario A Coruña, Spain.
authors.forename: Irene
authors.initials: I
authors.lastname: Garcia Hernandez
authors.affiliation: Department of Pediatric Cardiology, Instituto de Investigación Biomédica (Cardiopatía Estructural y Congénita) y Complexo Hospitalario Universitario A Coruña, Spain Department of Cardiology, Instituto de Investigación Biomédica (Cardiopatía Estructural y Congénita) y Complexo Hospitalario Universitario A Coruña, Spain.
authors.forename: Isaac
authors.initials: I
authors.lastname: Martinez-Bendayan
authors.affiliation: Department of Pediatric Cardiology, Instituto de Investigación Biomédica (Cardiopatía Estructural y Congénita) y Complexo Hospitalario Universitario A Coruña, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Rueda
authors.affiliation: Department of Cardiovascular Surgery, Instituto de Investigación Biomédica (Cardiopatía Estructural y Congénita) y Complexo Hospitalario Universitario A Coruña, Spain.
authors.forename: Jose J
authors.initials: JJ
authors.lastname: Cuenca Castillo
authors.affiliation: Department of Cardiovascular Surgery, Instituto de Investigación Biomédica (Cardiopatía Estructural y Congénita) y Complexo Hospitalario Universitario A Coruña, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Portela Torron
authors.affiliation: Department of Cardiovascular Surgery, Instituto de Investigación Biomédica (Cardiopatía Estructural y Congénita) y Complexo Hospitalario Universitario A Coruña, Spain victor.bautista.hernandez@sergas.es.
authors.forename: Victor
authors.initials: V
authors.lastname: Bautista-Hernández
mesh_terms: D000293:Adolescent; D000328:Adult; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D017060:Patient Satisfaction; D056346:Sternotomy / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Congenital heart disease; Lower mini-sternotomy; Minimally invasive cardiac surgery