Anesthesia for Port-Access cardiac surgery in a pediatric population

Objective: A less invasive approach to cardiac surgical procedures has become widely accepted. The Port-Access (Heartport Inc, Redwood City, CA) technique for correction of acquired and congenital heart defects in adults produces superior cosmetic results without increasing perioperative morbidity. This study evaluated the feasibility of the Port-Access approach for repairs of various congenital heart defects in children and describes the anesthetic management for this procedure. Design: Prospective observational study. Setting: University hospital. Participants: Ten 3- to 15-year-old patients. Interventions: Patients underwent repairs of congenital heart defects via minimal right thoracotomy. The induction and maintenance of anesthesia were tailored to achieve early extubation. Endotracheal intubation with a double-lumen tube was performed in 3 patients with body weight more than 25 kg. In other patients, lung separation was achieved with the use of a bronchial blocker. Arterial and venous cannulation were done under transesophageal echocardiography (TEE) guidance. A small surgical incision was performed in the fifth right intercostal space. In most patients, operations were performed on a fibrillating heart in normothermic condition. Results: TEE-guided cannulation posed no technical difficulties. Flow rates, calculated for patients' body surface area, were easily achieved. No inotropic support was necessary for the separation from cardiopulmonary bypass. All patients but 1 were extubated in the operating room. Despite longer times of operation and cardiopulmonary bypass, intensive care unit stay and postoperative hospital length of stay were not different from the historic matched control group and were 2.7 ± 1.1 days and 5.0 ± 1.6 days, respectively. Conclusions: The Port-Access method for the correction of selected congenital cardiac defects is feasible in children.