Application of an innovative aortic occlusion band technique in minimally invasive cardiac surgery for congenital heart disease

Objective To evaluate the safety and effectiveness of an innovative aortic occlusion band technique in minimally invasive surgery for congenital heart disease. Methods This retrospective, single-center cohort study included 1963 pediatric patients with ventricular septal defect who underwent right vertical infra-axillary thoracotomy between January 2018 and December 2024. Of these, 1097 were treated using the innovative occlusion band technique (IOB group), whereas 866 underwent conventional aortic crossclamping (CC group). All procedures were performed by a single surgeon. Adequacy of aortic occlusion in the IOB group was assessed under low-flow conditions according to circumferential band-tightening morphology and the adequacy of antegrade cardioplegia-induced cardiac arrest, rather than by any single pressure value alone. Results Among the 1963 eligible patients, 1097 (55.88%) were assigned to the IOB group and 866 (45.12%) to the CC group. No intraoperative conversion to median sternotomy occurred in either group. No patient in the IOB group required conversion to conventional aortic crossclamping, and no postoperative aortic complications, including aortic dissection or bleeding, were observed. Operative time, cardiopulmonary bypass time, and aortic crossclamp time were significantly shorter in the IOB group than in the CC group (all P < .001). In addition, incision length was significantly shorter in the IOB group than in the CC group (2.2 [2.0, 2.5] cm vs 2.7 [2.3, 3.5] cm, P < .001). No significant between-group differences were observed in postoperative length of hospital stay, duration of mechanical ventilation, or intensive care unit stay. Conclusions Application of the innovative occlusion band technique improves mobilization of the aortic root and may enhance effective use of the limited working field, thereby facilitating surgical manipulation. Importantly, this technique was also associated with a significantly shorter incision length compared with the conventional crossclamp technique, further supporting its minimally invasive advantage. These benefits were achieved without an increased risk of incomplete aortic occlusion, hematoma, or aortic dissection. Overall, the IOB technique represents a safe and effective adjunct for minimally invasive congenital cardiac surgery.