Minimally Invasive Congenital Cardiac Surgery in Morocco: Outcomes and Technical Refinements

Background Minimally invasive approaches are increasingly used in congenital cardiac surgery; however, their application remains challenging, particularly in pediatric patients. We report clinical outcomes and technical refinements for minimally invasive congenital cardiac surgery. Methods This prospective observational single-center study included 31 patients who underwent minimally invasive congenital cardiac surgery for atrial septal defects, ventricular septal defects, partial atrioventricular septal defects, and other selected lesions using cardiopulmonary bypass between January 2024 and January 2025. Patient selection was based on lesion complexity and anatomical accessibility. Data included demographic characteristics, echocardiographic findings, surgical approach, cannulation strategy, operative times, and postoperative outcomes. Results The study population consisted of 23 females and 8 males, with a median age of 145 months (range: 8-672) and a median weight of 32.5 kg (range: 9-89). Femoral arterial cannulation was performed in 27 patients, with combined femoral and internal jugular venous cannulation used when bicaval drainage was required. Mean aortic cross-clamp time was 51.2 min (range: 20-139). Extubation within 3 h was achieved in 93.5% (29/31) of patients. Mean intensive care unit stay and hospital stay were 2.06 days (range: 1-5) and 6.29 days (range: 4-15), respectively. There was no operative mortality and no conversion to median sternotomy. One of 31 patients (3.2%) developed postoperative atrioventricular block requiring permanent pacemaker implantation. Follow-up of at least 12 months shows satisfactory surgical results. Conclusions Minimally invasive congenital cardiac surgery is feasible and safe in selected patients. These approaches should be considered as part of a modern congenital cardiac surgery program.