# Upper partial sternal split for pediatric cardiac surgery

## TL;DR

This paper reports on a new surgical technique for pediatric heart surgery that avoids full chest incisions and has good outcomes.

## Contribution

The paper introduces and evaluates the upper partial sternal split as a safe and cosmetically preferable surgical approach for selected pediatric cardiac operations.

## Key findings

- The upper partial sternal split was used in 51 pediatric patients with no mortality and no need for full sternotomy during surgery.
- Most patients had short ICU and hospital stays, and many were extubated quickly with no wound complications.

## Abstract

We introduced the use of an upper partial sternal split for pediatric cardiac surgical procedures in our unit in 2016. We report the outcomes of our experience in 51 patients using this approach.

From February 2016 to September 2022, 51 patients underwent congenital cardiac surgical procedures using an upper partial sternal split including vascular ring repair (n = 20), subaortic membrane (n = 12), ventricular septal defect closure with aortic valve resuspension (n = 9), aortic arch repair (n = 4), pulmonary artery band (n = 2), pulmonary artery sling (n = 1), supravalvular aortic stenosis (n = 1), aortic valve replacement (n = 1), and pulmonary artery plasty (n = 1). The surgical approach involved a midline skin incision, based on the manubrium, followed by an upper manubriotomy. No special surgical instrumentation was required. Median patient age was 2.9 years (IQR 1.3, 6.0); median body weight was 15 kg (IQR 9.8, 20).

There was no mortality and no patient required intraoperative conversion to full sternotomy. One patient required re-exploration for bleeding when the incision was converted to a full sternotomy. There were no wound complications in any patient. Twenty-one patients (41%) were extubated on the table and of the remaining 30 patients, 23 patients (76%) were extubated within 24 h of surgery. Eleven patients did not require intensive care unit (ICU) admission. Median ICU and hospital stay was 1 day (IQR 1, 1.25) and 5 days (IQR 4, 8) ,respectively.

An upper partial sternal split approach is straightforward and can be performed safely with a preferable cosmetic result in selected pediatric cardiac operations.

The online version contains supplementary material available at 10.1007/s11748-023-01996-7.