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J Thorac Cardiovasc Surg 2009;138:933-936
© 2009 The American Association for Thoracic Surgery

Congenital Heart Disease

Minimally invasive operation for congenital heart disease: A sex-differentiated approach

^a Pediatric and Congenital Cardiac Surgery Unit, University of Padua, Padua, Italy
^b Department of Anesthesia, University of Padua, Padua, Italy
^c Department of Statistics, University of Padua, Padua, Italy

Received for publication September 22, 2008; revisions received January 14, 2009; accepted for publication March 8, 2009.

^_* Address for reprints: Giovanni Stellin, MD, Pediatric and Congenital Cardiac Surgery Unit, University of Padua, Via Giustiniani 2, 35128–Padua, Italy. (Email: giovanni.stellin{at}unipd.it).

Objectives: 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.