Vertical Right Axillary Mini-Thoracotomy for Correction of Ventricular Septal Defects and Complete Atrioventricular Septal Defects

Abstract

Background. Vertical right axillary mini-thoracotomy (VRAMT) is the standard approach for correction of atrial septal defect and partial atrioventricular septal defect at our institution. This observational single-center study compares our initial results with the VRAMT approach for the repair of ventricular septal defect (VSD) and complete atrioventricular septal defect (CAVSD) in infants and children to an approach using standard median sternotomy (MS). Methods. The perioperative courses of patients undergoing VSD and CAVSD correction through either a VRAMT or an MS were analyzed retrospectively. The surgical technique for the VRAMT involved a 4-to 5-cm vertical incision in the right axillary fold. Results. Of 84 patients, 25 (VSD, n [ 15; CAVSD, n [ 10) underwent correction through a VRAMT approach, whereas 59 (VSD, n [ 35; CAVSD, n [ 24) had repair through MS. VSD and CAVSD groups were comparable with respect to age and weight. No significant differences were observed for aortic cross-clamp duration, intensive care unit stay, hospital stay, and echocardiographic follow-up. There was no need for any conversion from VRAMT to MS in any case. Neither wound infections nor thoracic deformities were observed in both groups. Conclusions. VRAMT can be considered as a safe and effective approach for the repair of VSD and CAVSD in selected patient groups, and the outcome data appear comparable to those of MS.

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

“…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.…”

Toward Routine Minimally Invasive Ventricular Septal Defect Closure Via Right Lateral Minithoracotomy

“…Wang et al ( 10 ) performed VSD closure right vertical infraaxillary thoracotomy (RVIAT) in 274 patients, and they commented that the RVIAT can be performed with favorable cosmetic and clinical results for VSD closure. Similarly, Heinisch et al ( 14 ) performed VSD and complete AVSD correction in 84 patients with vertical right axillary mini-thoracotomy ( n = 25) and median sternotomy ( n = 59). No significant differences were observed for aortic cross-clamp duration, intensive care unit stay, hospital stay, and echocardiographic follow-up.…”

Minimally Invasive Cardiac Surgical Procedures in Children

“…13 More recently, however, a vertical skin incision at the midaxillary line has been proposed and results described in large series. 14 Proponents of this approach, while enthusiastic about the cosmetic result, admit that central cannulation is more challenging compared to the anterior minithoracotomy as the aorta and both cavae are farther away with the transaxillary approach. Thus, most recommend familiarity with the submammary incision before taking on the transaxillary approach.…”