Surgical repair via submammary thoracotomy, right axillary thoracotomy and median sternotomy for ventricular septal defects

Hong, Zhi-Nuan; Chen, Qiang; Lin, Zewei; Zhang, Gui-Can; Chen, Liangwan; Zhang, Qiliang; Cao, Hua

doi:10.1186/s13019-018-0734-5

Cited by 30 publications

(34 citation statements)

References 13 publications

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“…Technical challenges like central aortic cannulation, asymmetric breast development, defibrillation, and difficult deairing from the ventricle are well documented. In 2018 Hong et al [14] published data of 182 patients, showing that the surgical success rate of VSD repair via right sub-mammary thoracotomy and right vertical infra-axillary thoracotomy was similar to median sternotomy, which means all the three methods can achieve satisfactory clinical results. Based on their findings, they recommended that right sub-mammary thoracotomy and right vertical infra-axillary thoracotomy be used as effective and safe alternatives in VSD surgical repair.…”

Section: Discussionmentioning

confidence: 99%

Repair of ventricular septal defect through anterolateral thoracotomy with central cannulation: our experience

Dixit

Sharma

Suthar

et al. 2020

Indian J Thorac Cardiovasc Surg

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Background At present thoracotomy with femoro-femoral bypass is an established approach for minimally invasive open heart surgeries, but thoracotomy with conventional cannulation is yet to be established. We performed 54 cases of ventricular septal defect (VSD) closure via anterolateral thoracotomy approach with central cannulation. Here we are describing our results and experience of VSD closure via anterolateral thoracotomy approach. Aim and objective The aim of our study was to evaluate early outcomes of VSD repair via anterolateral thoracotomy with central cannulation. Methods This is a retrospective, observational, descriptive type of study. Fifty four patients (31 males, 23 females) underwent VSD repair from November 2016 to November 2018 via anterolateral thoracotomy with age ranges from 3 to 22 years (mean age 10.57 + 8.88 years). Mean body weight was 22.29 + 13.44 kg (range 10 to 48 kg). The VSD was perimembranous in 47 patients, subpulmonic in 2, muscular in 2, and inlet in 3 patients. Results There was no operative or late mortality. The mean incision length was 7.16 ± 02.08 cm (range, 5 cm to 9 cm). Average duration of cardiopulmonary bypass (CPB) was 61.72 ± 14.20 min (range, 48-78 min), and aortic cross-clamp time was 38.51 ± 13.08 min (range, 26-56 min). The average postoperative intensive care unit (ICU) stay was 1.83 ± 1.32 days (range, 1-3 days), and hospital stay was 4.92 ± 1.82 days (range, 4-7 days). Conclusion Anterolateral thoracotomy with conventional central cannulation can be a safe alternative to median sternotomy with superior cosmetic results for the repair of VSDs.

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Section: Discussionmentioning

confidence: 99%

Repair of ventricular septal defect through anterolateral thoracotomy with central cannulation: our experience

Dixit

Sharma

Suthar

et al. 2020

Indian J Thorac Cardiovasc Surg

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“…In our cardiac center, a median incision or a right infra-axillary incision is typically chosen. Our surgical teams found no statistically significant differences in the time of CPB, aortic clamping, operative time or prognoses between the median incision and the infra-axillary incision [4]. Many articles describe the advantages and disadvantages of transcatheter device closure of VSD [13, 14].…”

Section: Discussionmentioning

confidence: 99%

“…Ventricular septal defect (VSD) is the most common type of congenital heart disease (CHD) [1, 2]. The gold standard of treatment is surgical repair under cardiopulmonary bypass (CPB) [3], but this procedure is associated with a visible scar, long postoperative hospital stay and probable thoracic deformation [4]. In recent years, transthoracic device closure of VSD has been widely used, especially in China.…”

Section: Introductionmentioning

confidence: 99%

Changes in the levels of inflammatory markers after transthoracic device closure of ventricular septal defects in pediatric patients

Huang

Chen

Kuo

et al. 2019

J Cardiothorac Surg

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Background Transthoracic device closure of ventricular septal defect (VSD) is widely used in the clinic, especially in China. Changes in inflammatory marker levels after transthoracic device closure of VSD in pediatric patients have not been reported. Methods We retrospectively collected clinical data for 85 pediatric patients in our hospital from September 2017 to January 2018. The patients were divided into two groups according to treatment (device group vs. surgical group). The clinical and experimental data from the two groups were statistically analyzed. Results Clinical outcomes were good in all patients without any fatal complications. Similar increasing trends in inflammatory markers (white blood cell (WBC) count, procalcitonin (PCT), C-reactive protein (CRP), and interleukin-6 (IL-6)) were found in the two groups, both of which showed noticeable systemic inflammatory responses. In addition, no significant difference in the postoperative levels of inflammatory markers was observed between these two groups. Conclusions Although transthoracic device closure of VSD seems to be less traumatic and involves a quicker recovery, it also induces a systemic inflammatory response as measured by WBC count and PCT, CRP and IL-6 levels, and the altered trends in inflammatory markers were similar to those of conventional surgery under CPB.

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“…In an effort to reduce the surgical trauma, for the purpose of early rehabilitation of patients and in order to achieve a good cosmetic effect, few researchers from large cardiac surgery centers in the world eliminate isolated defects of the heart septum and some congenital defects associated with them using different options for right-sided thoracotomy. [14][15][16][17][18][19][20][21] The use of this approach, in contrast to the longitudinal median sternotomy, preserves the musculoskeletal frame of the chest, reduces surgical trauma, reduces the frequency of purulent-septic complications, gives a good cosmetic effect, shortens the patient's stay in the hospital, accelerates rehabilitation, and, consequently, reduces treatment costs.…”

Section: Methodsmentioning

confidence: 99%

Right thoracotomy - an alternative surgical access in the surgery of congenital heart defects

2021

jcdr

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Background: In this report presented the results of surgical correction in septal defects associated with congenital heart defects from right-sided lateral thoracotomy. Carried out comparative assessment of perioperative indicators, such as the duration of the operation, the duration of artificial circulation, the duration of artificial ventilation of the lungs, the time of staying patients in the intensive care unit and postoperative hospital days in patients operated from right-sided lateral thoracotomy and standard longitudinal sternotomy.Methods: Were analyzed the results of surgical treatment of 150 patients with isolated heart septal defects, a combination of heart septal defects with pulmonary artery stenosis, with anomalies of the inflow of the pulmonary veins, with atrioventricular valve pathologies, as well as with aortic valve insufficiency. All patients were divided into two groups of equal number of patients. I -group (main group) of 75 patients operated on from a right-sided lateral thoracotomy. II -group (control group) 75 patients operated on from a median longitudinal sternotomy.Results: In the group of patients operated from lateral thoracotomy, there was a significant reduction in the total duration of operation, a shortening of the time of artificial lung ventilation, the length of stay of patients in the intensive care unit and reduction of postoperative hospital days. The duration of cardiopulmonary bypass among patients of both groups did not differ significantly, being 35.6 ± 3.45 minutes in the main group, and 39.48 ± 3.48 minutes in the control group, p = 0.43.All performed operations from right-sided thoracotomy access proceeded without technical difficulties, and the stages of elimination of existing defects were carried out in full according to the standard protocol. In no case was there a need for conversion. Patients were particularly satisfied with the achieved cosmetic effect. Conclusions:Based on the obtained results, the authors of the report came to the conclusion that right-sided thoracotomy can be used as an alternative surgical access to the standard sternotomy access in the surgery of septal defects and some congenital heart defects associated with it in conditions of artificial circulation. This access is less traumatic, better tolerated by patients and subsequently gives fewer complications.

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Surgical repair via submammary thoracotomy, right axillary thoracotomy and median sternotomy for ventricular septal defects

Cited by 30 publications

References 13 publications

Repair of ventricular septal defect through anterolateral thoracotomy with central cannulation: our experience

Repair of ventricular septal defect through anterolateral thoracotomy with central cannulation: our experience

Changes in the levels of inflammatory markers after transthoracic device closure of ventricular septal defects in pediatric patients

Right thoracotomy - an alternative surgical access in the surgery of congenital heart defects

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