Horizontal right Axillary minithoracotomy: Aesthetic and effective option for ventricular and atrial septal defect repair in infants and toddlers.

Abstract

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.

Right Axillary Thoracotomy in Congenital Cardiac Surgery: Analysis of Percutaneous Cannulation

“…Furthermore, VRAMT procedures can be performed using standard instruments for access and the J o u r n a l P r e -p r o o f 10 correction itself. These findings confirm previously reported advantages and results by other groups [4,5,13,20,21].…”

“…The ongoing general strategy for less invasive procedures has increased the quest for minimally invasive accesses, also in the field of corrective heart surgery. Several publications have shown that less invasive thoracic incisions can be safely applied for the correction of simple congenital heart defects in pediatric patients [3,5,13,19]. The right axillary minithoracotomy was developed to improve the cosmetic results while allowing equal surgical outcome for corrective heart surgery (e.g.…”

“…This access is considered as rather invasive, it results in a well visible scar on the midline of the chest. Especially in growing children, the resulting stigma of being a "heart patient" can lead to long lasting psychological distress [3][4][5].…”

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

“…Furthermore, VRAMT procedures can be performed using standard instruments for access and the correction itself. These findings confirm previously reported advantages and results by other groups [4,18,[23][24][25].…”

“…The use of less invasive lateral thoracotomy in pediatric patients for the correction of congenital heart defects has been reported as feasible and safe in various publications [4,5,18,23,24]. VRAMT aims to provide superior cosmetic results without compromising the surgical outcome when employed for congenital heart defects, such as ASD, VSD, and PAVSD.…”