Minimally invasive cardiac surgery is becoming a safe and cosmetic alternative to standard median sternotomy (SMS). This retrospective study reviews our results and experience with the lower mini-sternotomy (LMS) technique and the right lateral thoracotomy (RLT) technique for ventricular septal defect (VSD) closure compared with SMS.

Between January 2013 and Dec 2015, 198 patients underwent repair VSD through lower mini-sternotomy (LMS Group, n=66), right lateral thoracotomy (RLT Group, n=59), standard median sternotomy (SMS Group, n=73). Cardiopulmonary bypass was achieved directly in the three different approaches.

Procedures were performed successfully in all patients among the three groups and no in-hospital mortality occurred. No patient was reverted to standard median sternotomy in the LMS Group and RLT Group. The CPB time was 37.73±11.46 mins in the LMS Group, 41.3±13.97 mins in the RLT Group and 36.99±10.84 mins in the SMS Group (p=0.078); the cross-clamp times were 23.85±9.78 mins in the LMS Group, 22.54±9.08 mins in the RLT Group and 19.23±6.92 mins in the SMS Group (p=0.009). The total incision length of the procedure in the SMS Group (7.45±1.54cm) was longer than the other groups (LMS Group, 5.58±0.8cm and RLT Group, 5.96±1.48cm) and the difference was significant (p<0.001).

Both the LMS and RLT approach can be performed with favourable cosmetic and acceptable clinical results for closing VSD. They are the promising alternatives to standard median sternotomy and merit further study.