Minimally invasive cardiac surgical techniques are increasingly applied in the treatment and management of a variety of adult ventricular septal defects (VSDs). However, repair of adult subarterial VSDs via left anterior mini-thoracotomy is rarely reported. The present study aimed to determine the feasibility and safety of the left anterior mini-thoracotomy for the repair of adult subarterial VSDs. Twenty-seven adult patients underwent repair of subarterial VSDs via left anterior mini-thoracotomy. The approach includes two options for skin incision access, longitudinal and transverse skin incisions. The skin incision length was 4.1–6.1 cm (mean, 5.1 ± 0.6 cm). The closure of the VSDs was obtained through the main pulmonary artery under direct visualization. Successful repair of the defects was achieved in all the patients. No patients died or converted to median sternotomy. Average durations of cardiopulmonary bypass (CPB) and aortic cross-clamp were 102.5 ± 13.6 min (range, 85–127 min) and 54.6 ± 6.9 min (range, 45–66 min), respectively. No patients required blood transfusion. The average postoperative hospital stay was 5.1 ± 0.7 days (range, 4–6 days). There were no postoperative complications related to the operative procedures or peripheral cannulation. During the follow-up of 5.4–32.3 months, no patients were found to have residual shunt, wound infections, pericardial effusion, neurologic or other complications. Our experiences demonstrate that minimally invasive cardiac surgical technique via left anterior mini-thoracotomy can be served as a novel, feasible and safe alternative for the repair of adult subarterial VSDs.

Acute type A aortic dissection (ATAAD) is a critical and life-threatening condition. To date, surgical intervention remains the primary life-saving treatment. However, this surgical approach is often accompanied by a range of postoperative complications, and the associated mortality rate remains high. In this study, we introduced an innovative technique that utilized tetrafurcate graft eversion for suturing and reinforcing the aortic root, in conjunction with a single-branched stent technique, for the management of ATAAD. A total of eighty-nine ATAAD patients who underwent surgical treatment at Ganzhou People’s Hospital between January 2021 and March 2024 were enrolled in this study. The patients were divided into two groups based on the surgical technique employed: a conventional group (n = 57) and an modified-technique group (n = 32). A comprehensive analysis of perioperative outcomes was conducted. There were no statistically significant differences in preoperative characteristics between the two groups. The intraoperative cardiopulmonary bypass (CPB) time, assisted-circulation time (ACT), and total operation time in the modified-technique group were significantly shorter than those in the conventional group (P = 0.027, P = 0.009, and P = 0.012, respectively). Moreover, patients in the modified-technique group had less drainage on the first postoperative day (P = 0.011), shorter ventilation time, intensive care unit (ICU) stay, and postoperative in-hospital stay (P = 0.014, P = 0.028, and P = 0.017, respectively), as well as a lower postoperative in-hospital mortality rate (P = 0.035)​. Combining tetrafurcate graft eversion for aortic root suturing and reinforcement with single-branched stent implantation offers a simplified, safe, and effective approach for treating ATAAD.