Minimally Invasive Surgical Correction Of Congenital Heart Defects Via Lower Partial Sternotomy
Joshybaev S.D., Mukhamedov Ikromzhon, Alibekov A.A., Rozbaev Z.N., Kenbaev A.B., Zelentsova A.A., Ukolova Y.N., Salikhodjayev M.M.

Scientific and Clinical Center of Cardiac Surgery and Transplantology,Taraz, Kazakhstan

BACKGROUND
Surgicalcorrectionofsimplecongenitalheartdefects,includingventricularseptaldefects(VSD),pulmonaryarterystenosis,andtetralogyofFallot,canbeperformedvialowerpartialsternotomy.Thisminimallyinvasiveapproachpreservesthesternalmanubrium,reducestheriskofsternalfractures,andallowsconcealmentofthesurgicalscar,improvingcosmeticoutcomes

METHODS
SinceJanuary2025,11patientsunderwentcorrectionvialowerpartialsternotomy:7VSDclosures(5inlet,2outletwithseverepulmonaryhypertension),1VSDwithpulmonaryarterystenosis,1isolatedpulmonaryarterystenosis,and1tetralogyofFallot.Patientsincluded5femalesand6males,meanage1.7±1.5years,meanweight9.8±4.0kg,andmeanbodysurfacearea0.29±0.18m².Thesternumwasdividedfromthelowerportiontothemanubrium,pericardiumopenedwithoutthymusinvolvement.Cardiopulmonarybypasswasviacentralcannulation;openpulmonaryvalvuloplastywasperformedonthebeatingheart.Intraoperativetransesophagealechocardiographyguidedtheprocedures

RESULTS

Noin-hospitalmortalityormajorcomplicationsoccurred.Meanoperativetimewas210.5±38.3minutes,CPB93.7±38.1minutes,andaorticcross-clamp67.5±28.1minutes.Meanintraoperativebloodlosswas131.0±75.5mL.ICUstayaveraged57.6±51.7hours;hospitalstay9.0±5.1days.Predischargeechocardiographyshowednoresidualshunts

CONCLUSIONS
Lowerpartialsternotomyforthecorrectionofventricularseptaldefects,includingthosecombinedwithpulmonaryvalvestenosis,isasafeandeffectivesurgicalapproachthatprovidessatisfactoryclinicalandaestheticoutcomes