The Right Axillary Incision: A Potential New Standard of Care for Selected Congenital Heart Surgery

Lee, Timothy J.; Weiss, Aaron; Williams, Elbert E.; Kiblawi, Fuad; Dong, Joanna; Nguyen, Khanh

doi:10.1053/j.semtcvs.2018.02.011

Cited by 25 publications

(42 citation statements)

References 13 publications

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“…Younger age is not a contraindication as it is possible even in infants. 4,5,10 Heinisch et al have demonstrated use of this approach for successful closure of ventricular septal defects and complete atrioventricular septal defects in 25 patients aged 4.3 months (3.3-6.3) with median weight of 5 kg (4.4-6.2) with results comparable to the median sternotomy approach. 10 A 4- to 5-cm incision gives adequate exposure.…”

Section: Resultsmentioning

confidence: 99%

“…As Lee et al have shown in their similarly cosmetic transverse axillary approach, as experience grows and with refinement of instrumentation, the axillary approach can be used in the surgical treatment of a broad spectrum of congenital heart defects. 5…”

Section: Commentmentioning

confidence: 99%

“…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%

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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

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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.

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Section: Resultsmentioning

confidence: 99%

Section: Commentmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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

show abstract

“…Currently an increasing number of procedures are performed through a minimal invasive approach. This spectrum of diseases ranges from corrections of simple defects such as atrial septal defects (ASDs) and ventricular septal defects (VSDs), to tetralogy of Fallot repair and mitral valve repair, further incorporating repairs of atrioventricular septal defect and isolated pulmonary stenosis, extra-cardiac Fontan, and ventricular assist device placement (6,(16)(17)(18)(19). The minimal access approaches that have been described to address these pathologies reveal a wide surgical armamentarium.…”

mentioning

confidence: 99%

“…The minimal access approaches that have been described to address these pathologies reveal a wide surgical armamentarium. This includes upper or lower mini-sternotomy, submammary and posterior thoracotomy incision, axillary incisions and incisions used in roboticassisted procedures (6,(16)(17)(18)(19). Additionally, it extends to video-assisted thoracoscopic surgical (VATS) treatment of vascular rings, ligation of patent ductus arteriosus (PDA) and sew on of epicardial leads (6).…”

mentioning

confidence: 99%