Minimally Invasive Techniques in Congenital Heart Surgery

Minimally invasive approaches to congenital cardiac repair have evolved to reduce the physical and psychological impact of surgery, while preserving safety and effectiveness. By replacing or complementing the traditional median sternotomy with smaller thoracotomies, partial sternotomies or thoracoscopic methods, surgeons are able to achieve comparable intracardiac access with less trauma to bone and soft tissues. Techniques such as right vertical infra-axillary thoracotomy, subaxillary and anterolateral minithoracotomies, and totally thoracoscopic approaches have been adapted for common defects—including atrial septal defects (ASDs), ventricular septal defects (VSDs) and selected valve surgeries—across a wide age and weight spectrum. Benefits include reduced mechanical ventilation time, shorter intensive care and hospital stays, superior cosmetic outcomes and lower risk of chest wall deformity, without compromising cardiopulmonary bypass or aortic cross-clamp parameters. Careful patient selection and an individualised incision strategy are central to optimising outcomes and broadening applicability globally.

Research from Nature Portfolio

Recent long-term evaluation of a lateral infra-axillary incision demonstrates its safety and reproducibility in over a thousand patients undergoing patch closure of septal defects and valve procedures. Across a 15-year follow-up, no conversions to median sternotomy were required, operative mortality was negligible and late survival exceeded expectations. Patients uniformly reported high cosmetic satisfaction, and there were no significant chest wall deformities or asymmetrical breast development. These findings reinforce the technique as a viable standard alternative to full sternotomy for a broad range of congenital indications.

Minimally Invasive Techniques in Congenital Heart Surgery publication trend

The graph below shows the total number of articles in minimally invasive techniques in congenital heart surgery across all publications each year (not limited to Nature Index journals).

Technical terms

Atrial septal defect (ASD): A congenital opening in the atrial septum permitting shunting of blood between the left and right atria.

Ventricular septal defect (VSD): A congenital defect in the ventricular septum leading to left-to-right cardiac shunting at ventricular level.

Right vertical infra-axillary thoracotomy (RVIAT): A lateral chest incision below the axilla providing direct access to anterior cardiac structures without sternal division.

Right subaxillary small incision (RSSI): A limited lateral chest approach situated beneath the axilla, used for paediatric septal defect repair.

Cardiopulmonary bypass (CPB): A technique using an external pump and oxygenator to maintain circulation and gas exchange during cardiac surgery.

Propensity score matching: A statistical method that balances treatment groups in observational studies by equating covariates.

References

1. Early- and Long-term Outcomes of Cardiovascular Surgery via Minimal Right Vertical Infra-axillary Thoracotomy: A 15-year Study of 1,126 Patients. Scientific Reports (2018).
2. Right subaxillary small incision on low-age and low-weight infants with congenital heart disease. Frontiers in Cardiovascular Medicine (2024).
3. Individualized strategy of minimally invasive cardiac surgery in congenital cardiac septal defects. Journal of Cardiothoracic Surgery (2022).
4. Right vertical axillary incision for atrial septal defect: a propensity score matched study. Journal of Cardiothoracic Surgery (2022).