Early- and Long-term Outcomes of Cardiovascular Surgery via Minimal Right Vertical Infra-axillary Thoracotomy: A 15-year Study of 1,126 Patients

Wang, Qiang; Ye, Jia-Xin; Ge, Min; Wang, Dongjin

doi:10.1038/s41598-018-22824-6

Cited by 14 publications

(10 citation statements)

References 22 publications

(21 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Studies have shown that the right infra-axillary thoracotomy incision is mostly made vertically (28,29). We performed the thoracotomy skin incision parabolically to reduce skin necrosis due to tension caused by the thorax retractor.…”

Section: Discussionmentioning

confidence: 99%

Our results of cardiac surgery performed with a right infra axillary mini thoracotomy

Gemalmaz

Gültekin

2021

Journal of Health Sciences and Medicine

View full text Add to dashboard Cite

The aim of the study is to share the technique and results of heart surgery performed with right infra-axillary mini thoracotomy. Materyal and Method: Between March 2013 and July 2014, 16 heart operations were performed with right infra-axillary mini thoracotomy incision. Patient data were analyzed retrospectively. These are 6 mitral valve replacement (MVR), 3 aortic valve replacement (AVR), 2 AVR+MVR, 2 atrial septal defect (ASD) repair, 1 myxoma excision. One of them is AVR+tricuspid ring annuloplasty operation and MVR performed due to reoperation. Radiofrequency (RF) ablation was also applied to 1 patient who underwent MVR due to atrial fibrillation. In these operations, thoracotomy was performed through the right anterior infra-axillary line. A parabolic incision of 6-8 cm was made at the 3rd intercostal space (ICA) for aortic valve interventions and at the 4th ICA level for other valve interventions. No special surgical instruments were used in the operations except standard surgical instruments. All cannulation procedures were carried out through the existing thoracotomy incision. Results: No mortality or morbidity was observed as a result of the operations. The mean extracorporeal circulation (ECC) time was 95±11 minutes, and the mean cross clamp (CC) time was 61±9 minutes. There was an average of 380±35 cc drainage. Extubation time was 7±2.3 hours on average. All patients were taken to the service after 1±0.5 day of intensive care treatment. They were discharged from the hospital in an average of 6±1.5 days. Incision site infection was not observed in any patient. No patients were revised due to bleeding. One patient who was ablated for atrial fibrillation (AF) developed postoperative AF again. He was discharged with medical treatment and speed control. Conclusion:In this study, we think that heart surgeries with right infra-axillary mini thoracotomy incision may be a good alternative to standard sternotomy and other minimally invasive methods in heart surgery. With standard surgical instruments and cannulation through a single incision, not only the mitral valve but also the aortic valve, tricuspid valve and other cardiac pathologies can be easily intervened. However, very good results are obtained in patients cosmetically.

show abstract

Section: Discussionmentioning

confidence: 99%

Our results of cardiac surgery performed with a right infra axillary mini thoracotomy

Gemalmaz

Gültekin

2021

Journal of Health Sciences and Medicine

View full text Add to dashboard Cite

show abstract

“…The incision is in the chest wall, which has low muscle mass and is far from the costochondral junction; it does not interfere with the development of the chest wall, particularly in young patients. In addition, femoral cannulation is not necessary [Casselman 2007, Wang 2018, thus it also avoids femoral artery injury. Second, this incision offers excellent visualization of mitral valve structures in a direct-line view.…”

Section: Discussionmentioning

confidence: 99%

“…A right infra-axillary incision has been widely used in our center for cosmetic purposes in young people as a good alternative to standard median sternotomy [Wang 2018]. It was first used to repair atrial septal defect, partial atrioventricular septal defect, and ventricular septal defect.…”

Section: Introductionmentioning

confidence: 99%

Mitral Valve Surgery via a Right Infra-axillary Thoracotomy in High-Risk Reoperative Patients

Cao

Zhou

Xue

et al. 2020

HSF

View full text Add to dashboard Cite

Background: A right infra-axillary thoracotomy can offer excellent exposure of the mitral valve. This study evaluated this incision for high-risk patients undergoing redo mitral valve procedures. Methods: Of a series of 189 patients who had redo mitral valve surgery, 32 were reoperated via vertical infra-axillary thoracotomy based on previous aortic valve replacement, dense adhesion, location of patent bypass grafts, and peripheral vascular disease. Results: Sternotomy was avoided in all cases. The mitral valve was replaced in 22 patients and repaired in 10 patients; left atrial folding was performed in 6 patients. All patients had uneventful outcomes and normal valve function during follow-up. Conclusions: Reoperative mitral valve surgeries can be performed safely using right infra-axillary thoracotomy in certain patients. The procedure offers excellent exposure of the mitral valve and minimizes the need for cardiac dissection, thus reducing injury risk. Avoiding a high risk of resternotomy increases patient comfort and safety.

show abstract

“…Atrial septal defects (ASDs) are treated surgically only when percutaneous techniques are technically not feasible because of large size or insufficient margins. The growing demand for minimally invasive and cosmetic approaches to surgery has contributed to development of many techniques that include right posterolateral thoracotomy, 2 inframammary anterior thoracotomy, 3 muscle-sparing horizontal, 4,5 or vertical axillary thoracotomy, 6,7 and mini/or subxiphoid sternotomy. 8,9 Of these techniques, axillary thoracotomy has significant advantages.…”

Section: Introductionmentioning

confidence: 99%

Transaxillary Approach for Surgical Repair of Simple Congenital Cardiac Lesions: Pitfalls, and Complications

Bayya

Kottayil

Srimurugan

et al. 2021

World J Pediatr Congenit Heart Surg

View full text Add to dashboard Cite

Background: In the treatment of simple congenital cardiac lesions, percutaneous and cosmetic surgical approaches have steadily gained prominence. Surgically, right vertical axillary approach is sparsely used despite superior cosmesis and less pain and blood product usage. Knowledge of potential pitfalls could lead to its more widespread acceptance. Methods: We retrospectively analyzed perioperative outcomes of 104 consecutive patients who underwent surgery by this technique between mid-2016 and December 2019, including ostium secundum (67), sinus venosus (34), coronary sinus (1), and ostium primum (1) atrial septal defects and hemianomalous pulmonary venous connection (1). Perioperative variables, surgical times, complications, and follow-up data were analyzed. Results: Patient weight ranged from 6.8 to 41 kg. Incision length ranged from 4 to 6 cm. There was no mortality. All cannulation was central. Difficulty in cannulation (inferior vena cava) was seen in two patients. Morbidity included pneumothorax in 2 (1.9%) patients and subcutaneous emphysema necessitating prolonged intercostal drain retention in 20 (19.2%) patients. Surgical time increased linearly (r = 0.567; P < .001) with increasing patient weight but cardiopulmonary bypass (CPB) time remained unaffected. No chest deformities or paresthesia were noted on follow-up. Scar size decreased in some patients. Conclusions: Right vertical axillary approach can be safely employed to treat simple congenital cardiac lesions with adequate awareness of potential pitfalls. Increasing patient weight increases the surgical time but does not affect CPB times. Incidence of pneumothorax and subcutaneous emphysema is similar to other thoracotomy approaches. It is cosmetically superior.

show abstract

Early- and Long-term Outcomes of Cardiovascular Surgery via Minimal Right Vertical Infra-axillary Thoracotomy: A 15-year Study of 1,126 Patients

Cited by 14 publications

References 22 publications

Our results of cardiac surgery performed with a right infra axillary mini thoracotomy

Our results of cardiac surgery performed with a right infra axillary mini thoracotomy

Mitral Valve Surgery via a Right Infra-axillary Thoracotomy in High-Risk Reoperative Patients

Transaxillary Approach for Surgical Repair of Simple Congenital Cardiac Lesions: Pitfalls, and Complications

Contact Info

Product

Resources

About