Objectives: Since 1996 we have routinely used minimally invasive gender differentiated surgical approaches (GDSA) for surgical repair of various simple congenital heart diseases, mostly including a right anterior mini-thoracotomy in females and a mid-line mini-sternotomy in males.
Methods: Between January 1996 and December 2004, all patients who underwent a GDSA were included. Hospital results were compared to a full sternotomy group (controls). Patient’s clinical condition and satisfaction at follow-up were evaluated.
Results: Three-hundred-eight patients had GDSA: 1) mini-thoracotomy in 147 (47.7%), 2) mini-sternotomy in 161 (52.3%). Thirty patients had a “full sternotomy” for atrial septal defect closure. The most common diagnosis was an atrial septal defect (231 patients, 75%). None of the patients required an extension of the surgical access. There were neither major complications nor hospital deaths. All patients were discharged home without residual defects. Median follow-up time was 71.5 months (48.2–85.7 months). There were no late deaths. No scoliosis, asymmetric breast development or lactation problems were reported in the mini-thoracotomy group. Twenty-five of 147 patients (17%) with mini-thoracotomy complained a trivial persistent (<6 months) sensitive skin deficit in the mammary area, most often localized at the infero-medial quadrant. The vast majority of patients (295/308, 96 %) were in NYHA class I and 282/308 patients (91.5%) were satisfied with the cosmetic result of surgery.
Conclusions: GDSA for simple congenital heart disease is a safe procedure, providing both excellent functional and cosmetic results. Antero-lateral mini-thoracotomy is a valid and highly appreciated procedure in female patients.