Introduction Congenital heart defects treatment shows progressive reduction in morbidity and
mortality, however, the scar, resulting from ventricular (VSD) and atrial septal
defect (ASD) repair, may cause discomfort. Right axillary minithoracotomy
approach, by avoiding the breast growth region, is an option for correction of
these defects that may provide better aesthetic results at low cost. Since October
2011, we have been using this technique for repairing VSD and ASD defects as well
as associated defects. Objectives To evaluate the efficacy of this method in children undergoing correction of VSD
and ASD, to compare perioperative clinical outcomes with those repaired by median
sternotomy, and to evaluate the aesthetic result. Methods Perioperative clinical data of 25 patients submitted to axillary thoracotomy were
compared with data from a paired group of 25 patients with similar heart defects
repaired by median sternotomy, from October 2011 to August 2012. Results Axillary approach was possible even in infants. There was no mortality and the
main perioperative variables were similar in both groups, except for lower use of
blood products in the axillary group (6/25) vs. control (13/25),
with statistical difference (P =0.04). The VSD size varied from 7
to 15 mm in axillary group. Cannulation of the aorta and vena cavae was performed
through the main incision, whose size ranged from 3 to 5 cm in the axillary group,
with excellent aesthetic results. Conclusion The axillary thoracotomy was effective, allowing for a heart defect repair
similar to the median sternotomy, with more satisfactory aesthetic results and
reduced blood transfusion, and it can be safely used in infants.
BackgroundExtracorporeal membrane oxygenation (ECMO) is increasingly being used to support patients after the repair of congenital heart disease.ObjectiveWe report our experience with patients with a single functional ventricle who were supported by ECMO after the Norwood procedure, reviewing the outcomes and identifying risk factors for mortality in these patients.MethodsIn this single-center retrospective cohort study, we enrolled 33 patients with hypoplastic left heart syndrome (HLHS) who received ECMO support after the Norwood procedure between January 2015 and December 2019. The independent variables evaluated in this study were demographic, anatomical, and those directly related to ECMO support (ECMO indication, local of initiation, time under support, and urinary output while on ECMO). The dependent variable was survival. A p < 0.05 was considered statistically significant.ResultsThe ECMO support was applied in 33 patients in a group of 120 patients submitted to Norwood procedure (28%). Aortic atresia was present in 72.7% of patients and mitral atresia in 51.5%. For 15% of patients, ECMO was initiated in the operating room; for all other patients, ECMO was initiated in the intensive care unit. The indications for ECMO in the cardiac intensive care unit were cardiac arrest in 22 (79%) of patients, low cardiac output state in 10 (18%), and arrhythmia in 1 patient (3%). The median time under support was 5 (2–25) days. The median follow-up time was 59 (4–150) days. Global survival to Norwood procedure was 90.9% during the 30-day follow-up, being 33.3% for those submitted to ECMO. Longer ECMO support (p = 0.004) was associated with a higher risk of death in the group submitted to ECMO.ConclusionsThe mortality of patients with HLHS who received ECMO support after stage 1 palliation was high. Patients with low urine output were related to worse survival rates, and longer periods under ECMO support (more than 9 days of ECMO) were associated with 100% mortality. Earlier ECMO initiation before multiorgan damage may improve results.
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