Heart, Lung and Circulation

The Evolution of the Minimally Invasive Approach and Conventional Median Sternotomy for Coronary Artery Fistula Correction


      Minimally invasive cardiac surgery has become a safe and cosmetic alternative to standard median sternotomy. This retrospective study reviews our results and experience with the minimally invasive approach for congenital coronary artery fistula correction, compared with conventional approach.


      From February 2001 to June 2016, 110 patients with isolated coronary artery fistula (CAF) in our centre underwent correction through minimally invasive approach (MIA) (n = 65) or standard median sternotomy (SMS) (n = 45). Cardiopulmonary bypass (CPB) was used in 16 patients in the SMS group, and all the other patients underwent the procedure without CPB through a standard median sternotomy or minimally invasive approach.


      There was no in-hospital mortality and no patients reverted to a median sternotomy in the MIA group. Subxiphoid incision (32 cases) and parasternal incision (28 cases) were the most common approaches used for the procedure. The operative time was 67.82 ± 14.4 minutes in MIA group and 107.04 ± 27.91 minutes (p = 0.0001) in the SMS group. The intubation time was 3.58 ± 2.33 hours in the MIA group and 6.1 ± 3.26 hours in the SMS group (p = 0.0001); the intensive care unit (ICU) stay was 10.04 ± 7.95 hours in the MIA group and 19.74 ± 7.81 hours in the SMS group (p = 0.0001). Three patients (two in MIA Group vs one in SMS Group, p = 0.787) were identified with a trivial residual shunt during the procedure, which had disappeared by discharge.


      Minimally invasive approach can provide an excellent surgical exposure for CAF ligation in selective patients compared with SMS. It is a safe and cosmetic alternative to conventional treatment and minimised the length of stay.


      CAF (Coronary artery fistula), RCA (Right coronary artery), RV (Right ventricular), LAD (Left anterior descending artery), MSCT (Multi-slice spiral computed tomography angiography), TEE (Transoesophageal echocardiography)


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