Minimally Invasive Cardiac Surgery in Children: Advanced Procedures for Pediatric Heart Health

Introduction

Minimally invasive surgical techniques are widely adopted and practiced for various surgical procedures. It has revolutionized the surgery concept, making it more comfortable for the patient. With the technological advancement in the medical field, many complex surgical procedures are now made accessible to patients in the form of minimally invasive techniques with zero compromises on the result of the treatment. However, not all medical conditions can be tackled with minimally invasive techniques. It does have specific challenges and limitations.

What Are Minimally Invasive Cardiac Surgery?

Minimally invasive cardiac surgery, as the name implies, is an innovative surgical approach where, unlike conventional surgery, the entire surgical procedure is carried out by gaining access to the cardiac defect through tiny incisions. Minimally invasive cardiac surgeries hold an elite position in pediatric cardiac surgery, where the technique is employed to correct inborn cardiac ailments.

Before the introduction of minimally invasive cardiac surgery, most heart treatments were done by making large incisions in the chest to open up the heart and its associated blood vessels to properly visualize the defective area and establish adequate access to the site to do the surgical correction. This is how conventional heart surgeries are performed. The extensive nature of the surgery often entails prolonged hospitalization and a healing period.

Minimally invasive cardiac surgical approaches have become an effective and promising surgical technique for dealing with cardiac defects earlier corrected by conventional techniques. Instead of large incisions and extensive surgical exploration, minimally invasive cardiac surgery employs remarkably smaller surgical openings. It is done with the help of specially designed equipment that is miniature in size and dimension compared to conventional surgical instruments. It is often incorporated with specific robotic devices. Through the smaller incision, these devices gain access to the site of action, which the doctors then control and regulate with the help of imaging modalities and other external guiding devices. It is the technological advancement that made the concept of minimally invasive cardiac surgery into reality.

What Are the Medical Conditions for Which Minimally Invasive Cardiac Surgery Is Advised in Children?

A broad spectrum of cardiac conditions in children can be effectively dealt with through minimally invasive cardiac approaches. Most inborn heart defects in child patients are often rectified through minimally invasive cardiac surgeries. Some of the medical conditions for which a minimally invasive cardiac approach is widely preferred are:

• Ventricular Septal Defects: The heart chambers on the right side are separated from those on the left side by a wall-like structure called a septum. The wall separating the two lower compartments (right and left ventricles) is medically known as the interventricular septum. Any perforation in the interventricular septum is denoted as a ventricular septal defect. When a child is diagnosed with a ventricular septal defect, a corrective surgical intervention is performed in infancy to close and secure the hole. Minimally invasive techniques are employed in such cases.

• Atrial Septal Defects: Perforation can develop in the wall separating the heart's upper two compartments (right and left atrium). Such defects are medically denoted by the name atrial septal defect.

• Tetralogy of Fallot: It is a peculiar inborn condition where the baby develops specific cardiac abnormalities during the intrauterine (within the womb) stage, restricting the normal functioning of the heart. It encompasses four defects that need surgical intervention to ensure unhindered heart functions.

• Atrioventricular Canal Defect: In an atrioventricular canal defect, the perforation develops at the intersection point of the ventricular and atrial septum. It completely disrupts cardiac functions.

• Valvular Pathology: It encompasses different developmental troubles associated with the valves responsible for guiding the blood flow in the specified direction through the heart chambers.

• Pulmonary Venous Anomalies: These are anomalies or defects associated with pulmonary veins that channel the oxygen-loaded blood from the lungs to the heart.

• Double Aortic Arch: It is another inborn condition where the child will be born with abnormalities in the aorta (critical blood vessels that deliver blood to the whole body).

What Are the Benefits Offered by Minimally Invasive Cardiac Surgery in Children?

Minimally invasive cardiac surgery maintains obvious and appreciable benefits over conventional cardiac surgeries. Some of the widely reported advantages concerning minimally invasive cardiac surgeries include the following:

• Small Incision: An appreciable reduction in the dimension and size of the surgical incision is a crucial advantage offered by minimally invasive cardiac surgeries. Smaller incisions restrict the trauma to the baby's body.

• Enhanced Healing: Since the physical trauma inflicted by the surgical technique is considerably low, post-surgery, the child exhibits an accelerated and speedy recovery.

• Turn Down the Hospitalization Period: Limited physical injury during the surgery aids in gearing down the hospital stay. The child can be discharged within a week.

• Exceptional Cosmetic Results: Minimally invasive cardiac surgeries leave undistinguishable scars compared to the obvious and pigmented scars following conventional cardiac surgery.

• No Chest Cracking: Open heart surgeries often involve cutting the breastbone (sternum) to establish proper access. In minimally invasive cardiac surgeries, no bone fractures need to be created, which in turn, preserves the integrity of the breastbone.

• Better Acceptance: Cardiac surgeries often pose anxiety and fear in patients. Minimally invasive cardiac surgeries are better accepted and adopted by patients.

• Diminishes the Risk of Complications: It significantly reduces the risk of post-operative discomforts like pain, swelling, and other health challenges associated with cardiac surgeries. Less surgery-induced tissue trauma checks the risk of bleeding.

What Are the Challenges Associated With Minimally Invasive Cardiac Surgery in Children?

Like any other surgical intervention, minimally invasive cardiac surgeries carry certain limitations and risks. Some of the potential challenges associated with minimally invasive cardiac surgery include the following:

• The technique underlying minimally invasive cardiac surgery is complex and demands a trained and expert panel of doctors to carry out the surgery.

• Minimally invasive cardiac surgeries are often quite expensive. Hence, these novel techniques cannot benefit patients from all socioeconomic categories.

• These surgical techniques are not advisable for all categories of cardiac defects. Proper assessment of the defect, anatomical considerations, age, and general health status of the child should be considered before advising minimally invasive cardiac surgeries in children. Patient selection is crucial to ensure the success of the procedure.

Conclusion

Technological progression is paving the way for the evolution of novel approaches for tackling complex cardiac anomalies and defects. Minimally invasive cardiac surgeries offer better and more promising treatment results, especially in children, thus enhancing pediatric cardiac care. Further research is ongoing to extend the applicability of this innovative approach. Minimally invasive cardiac surgeries in children are often guided by a panel of trained and skilled doctors, ensuring the treatment's success. Studies have demonstrated that minimally invasive cardiac approaches exponentially narrow down the morbidity as well as mortality associated with post-surgical complications.