Minimal Invasive Pediatric Cardiac Surgery: Clinical and Aesthetic Results

Although median sternotomy is the conventional approach for most congenital heart operations, minimally invasive techniques have been introduced over the past 20 years in various procedures. In our department, the right anterolateral minimal invasive thoracotomy approach has been used for ASD & VSD closures, mitral valve repairs & anomalous pulmonary venous return correction surgeries. The aim of this study was to evaluate the cosmetic results as perceived subjectively by the patients and their families by conducting a questionnaire incorporating questions on patients` well-being, physical & emotional perception, and overall subjective satisfaction from the overall outcomes.

Methods:
A validated questionnaire concerning the scar`s cosmetic effects on both male and female patients was presented over the phone to available 45 parents and/or patients out of 105 registered patients aged 23.5±18 years (mean age at time of operation: 14.7±9 y). All surgeries had good results with no major complications. Of these, 37 parents and/or patients completed the questionnaire, and 4 patients arrived to the hospital for visual evaluation and documentation of their surgical scar. Scores were 1 for best result to 5 for the worst result possible.

Results:
The long term post operative daily disability outcome score was 1.19±0.6, long term pain and discomfort score was 1.33±0.8, patients` aesthetic satisfaction score was 1.58±0.9, the chest & breast symmetry score was 1.5±1, for any chest or breast dysmorphic features score was 1.29±0.4, the scar`s influence on one`s self confidence score was 1.34±1, any discomfort while wearing a bra score was 1.55±1, any discomfort during nudity score was 1.32±.9 and any discomfort during intimacy score was 1.33±0.6.

Discussion:
Our center’s experience indicates that a small anterolateral thoracotomy scar is well tolerated, can be easily covered and has only minor effects on long term self-confidence and body perception among both male and female patients.