Document Detail

The limiting factors for the transxiphoid approach in congenital cardiac surgery.
MedLine Citation:
PMID:  15262613     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Minimally invasive cardiac surgery is currently being performed for a wide variety of cardiothoracic procedures. Since August 1998, the transxiphoid approach using a direct cannulation to the ascending aorta has been selected for the closure of atrial septal defects (ASD) and ventricular septal defects (VSD) in our institution. However, this approach cannot be performed for all patients because of the small "xiphoid window." We analyzed the factors limiting this approach to determine the best factor predicting risk. METHODS: Of 26 patients who had an ASD or a VSD, 14 underwent complete repair using a transxiphoid approach. Preoperative data collected for all patients included the relationship between the right ventricular outflow tract and the lower sternum (the RVSA) in the cineangiograph. Multiple logistic regression analysis was used to investigate which of the factors best predicted whether the transxiphoid approach should be adopted. RESULTS: The factors best predicting this approach were the combination of RVSA and body surface area (BSA) (odds ratios of 2.982 [P = .018] and 0.925 [P = .046], respectively). With the logistic model used in a prospective study of 6 consecutive patients, we were completely successful in predicting whether the transxiphoid approach could be performed. CONCLUSION: The combination of RVSA and BSA was the limiting factor for using the transxiphoid approach in congenital cardiac surgery.
Kagami Miyaji; Arata Murakami; Hajime Sato; Shinichi Takamoto
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Publication Detail:
Type:  Controlled Clinical Trial; Journal Article    
Journal Detail:
Title:  The heart surgery forum     Volume:  7     ISSN:  1522-6662     ISO Abbreviation:  Heart Surg Forum     Publication Date:  2004  
Date Detail:
Created Date:  2004-07-20     Completed Date:  2006-12-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100891112     Medline TA:  Heart Surg Forum     Country:  United States    
Other Details:
Languages:  eng     Pagination:  E250-3     Citation Subset:  IM    
Department of Cardiothoracic Surgery, University of Tokyo Hospital, Tokyo, Japan.
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MeSH Terms
Cardiac Surgical Procedures / methods*
Child, Preschool
Heart Septal Defects, Atrial / surgery*
Heart Septal Defects, Ventricular / surgery*
Treatment Outcome
Xiphoid Bone / surgery*

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