Partial Upper Sternal Pplit for Paediatric Cardiac Surgery: Preliminary Experience

Abstract

Background: A minimally invasive approach using an upper mini-sternotomy is established practice in adult cardiac surgery. We introduced the use of a partial upper sternal split for paediatric cardiac surgical procedures in our unit in 2016. Herein, we report the outcomes of our initial experience using this approach. Methods: Forty patients underwent cardiac surgical procedures for congenital heart defects by a single surgeon using an upper partial sternal split from February 2016 to December 2020. The surgical approach involved a midline skin incision, based on the manubrium, followed by an upper manubriotomy. No special surgical instrumentation was required. Results: Median age was 2.9 years (IQR 16 months-6.2 years). Median weight was 15.8 kg (IQR 10.7-20.8). Diagnoses are given in Table 1. There was no mortality. No child required conversion to full sternotomy. There was one reoperation for bleeding through the partial sternal split. Thirty-three (83%) patients were extubated within 24 hours of surgery. All patients who were ventilated for longer than 24 hours (n=7; 17%) had pre-existing bronchomalacia related to a vascular ring. There were no wound complications in any patient. Median intensive care unit and hospital stay was 1 day (IQR 1-1) and 5 days (IQR 4-8), respectively. Conclusions: An upper partial sternal split approach is simple and can be performed safely with good surgical outcomes in selected paediatric cardiac surgical operations. It results in a much smaller and cosmetically advantageous scar than conventional median sternotomy. [Formula presented]L20138243392022-03-11 <br />