Pediheart: Pediatric Cardiology Today
Jul 24, 2026 · 37 min · 7 segments
This week we discuss a recent report from the team at SickKids in Toronto on minimally invasive cardiac surgery. What sorts of operations are most common for this approach? Why are length of ICU and…
Robert PassHost
Christoph HallerGuest
The work begins by reminding us that congenital heart surgery has traditionally been performed through a median sternotomy, an approach that provides outstanding surgical exposure but leaves patients with a scar on their chest.
Over the past two decades, there's been a growing interest in minimally invasive techniques that have been driven by a desire to reduce surgical trauma, improve cosmetic outcomes, and speed post-operative recovery while maintaining the same high standards of safety and effectiveness.
Although minimally invasive approaches have become well-established in the adult cardiac surgical world, their adoption in children has been slower because of the technical challenges posed by smaller patients and the wide variety of congenital heart defects.
In this study we're about to review, the authors describe the development of a comprehensive single incision minimally invasive congenital heart surgery program outlining how their team gradually expanded the approach to an increasing number of patients and procedures.
They also evaluate the clinical outcomes of this program, asking whether minimally invasive surgery can be performed safely and reproducibly while delivering benefit to children and their families.
The authors described
And for this work, they used only cases using a limited vertical right mini thoracotomy with the use of cardiopulmonary bypass.
They explain that the types of procedures expanded over time from more simple repairs like atrial septal defect to more complex repairs like partial AV canal repairs or sinus venosus ASDs or VSD or mitral repair or even AV canal repairs.
They review the technique, and I would direct the reader to pages 998 to 999 for some of the details, as well as some photos.
I'm going to summarize the approach, but as a non-surgeon, I will likely screw some of this up, and so I suggest reading Dr. Haller's work for a more accurate description.
but in general terms the authors placed the patient in a 45 degree left lateral position with the right arm resting above shoulder height and they described performing a vertical thoracotomy anterior to the mid axillary line above the fourth intercostal space and they explained that most incisions were about three to three and a half centimeters long or about one to one and a half inches The lung would be retracted carefully after the ribs were opened and the pericardium opened longitudinally, one centimeter anterior to the phrenic nerve.
The repairs were all via a right atriotomy, though rarely through a left atriotomy via Waterston's groove directly into the left atrium for mitral surgery.
The surgery was then performed and they review how the heart was de-aired and the use of a single chest tube.
Following bypass and surgical completion, the authors worked towards extubation in the operating room with transfer to the ICU.
And interestingly, the majority of patients were in the ICU for less than a day before they were transitioned to a cardiac floor.
And to quote the authors, quote, patients who were hemodynamically stable for at least four hours post-operatively were eligible for transfer to the cardiology ward, close quotes.
The authors recorded all sorts of surgical data, including the types of surgeries, the bypass and cross clamp times, patient demographics, and post-operative details.
The authors review how adoption of this approach meant that over time, the percentage of secundum ASD patients having this approach rose from 30% of the patients at that center in the start to 82% by the end of the period.
They emphasize that the complexity of the repairs increased with time, with more complex operations described happening later in the time period of the study.
They note that over time, procedural times also shortened substantially, as did bypass and cross clamp times.
The work begins by reminding us that congenital heart surgery has traditionally been performed through a median sternotomy, an approach that provides outstanding surgical exposure but leaves patients with a scar on their chest.
Over the past two decades, there's been a growing interest in minimally invasive techniques that have been driven by a desire to reduce surgical trauma, improve cosmetic outcomes, and speed post-operative recovery while maintaining the same high standards of safety and effectiveness.
Although minimally invasive approaches have become well-established in the adult cardiac surgical world, their adoption in children has been slower because of the technical challenges posed by smaller patients and the wide variety of congenital heart defects.
In this study we're about to review, the authors describe the development of a comprehensive single incision minimally invasive congenital heart surgery program outlining how their team gradually expanded the approach to an increasing number of patients and procedures.
They also evaluate the clinical outcomes of this program, asking whether minimally invasive surgery can be performed safely and reproducibly while delivering benefit to children and their families.
The authors described
And for this work, they used only cases using a limited vertical right mini thoracotomy with the use of cardiopulmonary bypass.
They explain that the types of procedures expanded over time from more simple repairs like atrial septal defect to more complex repairs like partial AV canal repairs or sinus venosus ASDs or VSD or mitral repair or even AV canal repairs.
They review the technique, and I would direct the reader to pages 998 to 999 for some of the details, as well as some photos.
I'm going to summarize the approach, but as a non-surgeon, I will likely screw some of this up, and so I suggest reading Dr. Haller's work for a more accurate description.
but in general terms the authors placed the patient in a 45 degree left lateral position with the right arm resting above shoulder height and they described performing a vertical thoracotomy anterior to the mid axillary line above the fourth intercostal space and they explained that most incisions were about three to three and a half centimeters long or about one to one and a half inches The lung would be retracted carefully after the ribs were opened and the pericardium opened longitudinally, one centimeter anterior to the phrenic nerve.
The repairs were all via a right atriotomy, though rarely through a left atriotomy via Waterston's groove directly into the left atrium for mitral surgery.
The surgery was then performed and they review how the heart was de-aired and the use of a single chest tube.
Following bypass and surgical completion, the authors worked towards extubation in the operating room with transfer to the ICU.
And interestingly, the majority of patients were in the ICU for less than a day before they were transitioned to a cardiac floor.
And to quote the authors, quote, patients who were hemodynamically stable for at least four hours post-operatively were eligible for transfer to the cardiology ward, close quotes.
The authors recorded all sorts of surgical data, including the types of surgeries, the bypass and cross clamp times, patient demographics, and post-operative details.
The authors review how adoption of this approach meant that over time, the percentage of secundum ASD patients having this approach rose from 30% of the patients at that center in the start to 82% by the end of the period.
They emphasize that the complexity of the repairs increased with time, with more complex operations described happening later in the time period of the study.
They note that over time, procedural times also shortened substantially, as did bypass and cross clamp times.
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