Right Posterior-Lateral Minithoracotomy Access for Treating Congenital Heart Disease

Vida, Vladimiro L.; Padalino, Massimo A.; Bhattarai, Anil; Stellin, Giovanni

doi:10.1016/j.athoracsur.2011.06.069

Cited by 26 publications

(13 citation statements)

References 6 publications

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“…Surgeons then developed other approaches to reduce the invasiveness of complete median sternotomy and pursue better cosmetic results, especially in children, teenager and female patients [ 6 ]. These alternatives included lower mini-sternotomy incision [ 7 , 8 ], right submammary incision [ 9 , 10 ], right posterolateral thoracotomy incision [ 11 ] and right vertical infra-axillary incision [ 12 – 14 ].…”

Section: Discussionmentioning

confidence: 99%

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

Hong

Chen

Lin

et al. 2018

J Cardiothorac Surg

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BackgroundRight submammary thoracotomy and right vertical infra-axillary thoracotomy are performed for ventricular septal defect (VSD) to reduce the invasiveness of the conventional surgical repair through median sternotomy approach. No comparative studies have been conducted among these three procedures.MethodsFrom January 2016 to December 2016, 182 patients with isolated VSD who underwent surgical repair via one of these 3 approaches were reviewed to compare these three procedures.ResultsThe procedure success rates were similar in these three groups. There was no statistically significant difference in operative time, aortic cross-clamping time, the duration of CPB, blood transfusion amount and medical cost. However, postoperative mechanical ventilation time, the duration of intensive care and postoperative length of hospital stay were longer in median sternotomy group than the other two groups. (P < 0.05) The median sternotomy group required the longest incision. No significant difference was noted in major adverse events. There were different advantages and disadvantages in the three kinds of operative procedures.ConclusionsRegarding conventional surgical repair VSD, right submammary thoracotomy and right vertical infra-axillary thoracotomy both delivered better cosmetic results for patients with isolated VSD, while all the three procedures could obtain satisfactory clinical effect.

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Section: Discussionmentioning

confidence: 99%

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

Hong

Chen

Lin

et al. 2018

J Cardiothorac Surg

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“…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…”

Section: Introductionmentioning

confidence: 99%

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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“…Over the past decade, surgical correction of less severe congenital heart disease (CHD) such as ASD has been increasingly performed through minimally invasive less traumatic surgical approaches [3,4]. In particular, the advantage of total or partial peripheral cardiopulmonary bypass (CPB) includes the possibility of avoiding IVC snaring during CPB.…”

Section: Introductionmentioning

confidence: 99%

Minimally invasive congenital cardiac surgery with unsnared inferior vena cava

Guariento

Cattapan

Bertelli

et al. 2020

Preprint

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Here we report two cases of residual atrial septal defect (ASD) with inferior extension towards the inferior vena cava (inferior sinus venosus type). In both cases, patients underwent surgical repair of their ASD in childhood. However, signs of persistent hemodynamic right ventricular overload were detected at the last follow-up and a residual ASD was demonstrated. Both underwent successful minimally invasive surgical closure of the ASD by combining a right postero-lateral mini-thoracotomy (sub-axillary approach) and total peripheral cardiopulmonary bypass, avoiding snaring of the inferior vena cava. This allowed an optimal visualization of the residual intra-cardiac shunt and its subsequent closure.

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Right Posterior-Lateral Minithoracotomy Access for Treating Congenital Heart Disease

Cited by 26 publications

References 6 publications

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

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

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

Minimally invasive congenital cardiac surgery with unsnared inferior vena cava

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