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The clinical pathway for fast track recovery of school activities in children after minimally invasive cardiac surgery

Published online by Cambridge University Press:  18 April 2005

Masamichi Ono ,
Norihide Fukushima ,
Shigeaki Ohtake ,
Hajime Ichikawa ,
Koji Kagisaki ,
Tohru Matsushita  and
Hikaru Matsuda
Masamichi Ono
Affiliation:
Division of Cardiovascular Surgery, Department of Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
Norihide Fukushima
Affiliation:
Division of Cardiovascular Surgery, Department of Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
Shigeaki Ohtake
Affiliation:
Division of Cardiovascular Surgery, Department of Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
Hajime Ichikawa
Affiliation:
Division of Cardiovascular Surgery, Department of Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
Koji Kagisaki
Affiliation:
Division of Cardiovascular Surgery, Department of Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
Tohru Matsushita
Affiliation:
Division of Cardiovascular Surgery, Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
Hikaru Matsuda
Affiliation:
Division of Cardiovascular Surgery, Department of Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
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Abstract

Background: Minimally invasive cardiac surgery is now becoming standard in the correction of simple congenital cardiac malformations. We introduced a clinical pathway for fast track recovery of school activities in children after minimally invasive cardiac surgery, and assessed the function of the pathway in children with atrial or ventricular septal defects, comparing minimally invasive surgery to repair through a conventional full sternotomy. Methods: We studied 15 children of school age who underwent repair of an atrial or ventricular septal defect through a lower midline sternotomy, and 10 children undergoing repair through a full sternotomy. The clinical pathway was for extubation to take place in the operating room, echocardiographic evaluation on the 5th postoperative day, and discharge home on the 7th postoperative day, with return to school within 2 weeks, and resumption of all gymnastic activity within 6 weeks of the minimally invasive surgery. Results: In those having a lower midline sternotomy, postoperative hospital stay was 7.4 ± 0.8 days, with return to school 8.0 ± 2.4 days after discharge. They resumed gymnastics 41 ± 11 days after the minimally invasive surgery. In those having a full sternotomy, in contrast, these parameters were 13.5 ± 2.7, 23.1 ± 8.4, and 95 ± 43 days, respectively. Of the 15 children undergoing a minimally invasive approach, 12 (80%) fulfilled the criterions of our clinical pathway. Conclusions: We conclude that minimally invasive cardiac surgery can safely be performed in children. In addition to its cosmetic role, the technique has added value in promoting early return to normal school life, including gymnastics.

Keywords

Care pathwayscardiac surgeryrapid recovery
Type
Original Article
Information
Cardiology in the Young , Volume 13 , Issue 1 , February 2003 , pp. 44 - 48
Copyright
© 2003 Cambridge University Press

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References

Matsuda H. Minimally invasive cardiac surgery: principle and prospects. Surg Today 1998; 28: 775–779.Google Scholar
Cosgrove DM, Sabik JF. Minimally invasive approach for aortic valve operations. Ann Thorac Surg 1996; 62: 596–597.Google Scholar
Rao V, Freedom RM, Black MD. Minimally invasive surgery with cardioscopy for congenital heart disease. Ann Thorac Surg 1999; 68: 1742–1745.Google Scholar
Black MD, Freedom RM. Minimally invasive repair of atrial septal defects. Ann Thorac Surg 1998; 65: 765–767.Google Scholar
Gundry SR, Shattuck OH, Razzouk AJ, del Rio MJ, Sardari FF, Baily LL. Facile minimally invasive cardiac surgery via ministernotomy. Ann Thorac Surg 1998; 65: 1100–1104.Google Scholar
Taketani S, Sawa Y, Masai T, et al. A novel technique for cardiopulmonary bypass using vacuum system for venous drainage with pressure relief valve: An experimental study. Artificial Organs 1998; 22: 337–341.Google Scholar
Barbero-Marcial M, Tanamati C, Jatene MB, Atik E, Jatene ED. Transxiphoid approach without median sternotomy for the repair of atrial septal defects. Ann Thorac Surg 1998; 65: 3771–3774.Google Scholar
Massetti M, Babtasi G, Rossi A, et al. Operation for atrial septal defect through a right anterolateral thoracotomy: current outcome. Ann Thorac Surg 1996; 62: 1100–1103.Google Scholar
Grinda JM, Folliguet TA, Dervanian P, Mace L, Legault B, Neveux JY. Right anterolateral thoracotomy for repair of atrial septal defect. Ann Thorac Surg. 1996; 62: 175–178.Google Scholar
Chang CH, Lin PJ, Chu JJ, et al. Video-assisted cardiac surgery in closure of atrial septal defect. Ann Thorac Surg 1996; 62: 697–701.Google Scholar
Inoue Y, Yozu R, Mitsumaru A, Ueda T, Kawada S. Video-assisted cardioscopic staple closure for atrial septal defect. Artif Organs 1997; 21: 103–105.Google Scholar
Pearson SD, Kleefield MSF, Soukop JR, Cook EF, Lee TH. Critical pathways intervention to reduce length of hospital stay. Am J Med. 2001; 110: 175–180.Google Scholar
Lee JH, Swain B, Andrey J, Murrell HK, Geha AS. Fast track recovery of elderly coronary bypass surgery patients. Ann Thorac Surg. 1999; 68: 437–441.Google Scholar
Vricella LA, Dearani JA, Gundry SR, Razzouk AJ, Braner SD, Bailey LL. Ultra fast track in elective congenital cardiac surgery. Ann Thorac Surg 2000; 69: 865–871.Google Scholar