Aim
Minimally invasive techniques in the surgical treatment of congenital heart diseases
have gained popularity recently. Right infra-axillary vertical thoracotomy (RIAVT)
is one of these techniques. The aim of this study is to investigate the postoperative
morbidity and cosmetic results of the right infraaxillary thoracotomy technique and
compare them with the results in the literature.
Method
All patients who had undergone cardiac surgery using RIAVT at the Ankara City Hospital
Pediatric Cardiovascular Surgery Clinic between 2019 and 2021 were enrolled in the
study. Preoperative echocardiographic diagnoses, intraoperative surgical data and
postoperative morbidity data of the patients was obtained. In addition, surgical incision
length was measured and recorded for the evaluation of cosmetic outcome. This data
was then compared with data from similar studies in the literature.
Result
Between January 2019 and December 2021, 59 patients were operated on using RIAVT.
Of the RIAVT patients, 45 (76%) were female and 14 (24%) were male. The mean weight
of the patients was 22.38±12.48 kg. Although the youngest patient was a 5-month-old
infant weighing 4 kg, the oldest one was 15-years-old weighing 57 kg. Isolated secundum
atrial septal defect (ASD) repair (primary or patch) was performed in 47 patients.
One (1) patient with Primum ASD and mitral cleft, 1 patient with secundum ASD and
perimembranous ventricular septal defect (VSD) repair, nine patients with high venosum
ASD and PAPVC, and one patient with a discrete subaortic membrane were operated on.
The surgical incision length was between 4 to 5 cm.
Conclusion
RIAVT is an important surgical alternative to median sternotomy in selected cases
with certain pathologies. It can be performed safely in various congenital heart anomalies
and provides excellent functional and cosmetic results in the long-term when compared
to other surgical methods.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Heart, Lung and CirculationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Minimally Invasive Cardiac Surgical Procedures in Children.SAGE Publications, Los Angeles, CA2020: 95-98
- Patient attitudes to sternotomy and thoracotomy scars.Thorac Cardiovasc Surg. 2005; 53: 93-95
- Minimal right vertical infra-axillary incision for repair of congenital heart defects.Ann Thorac Surg. 2022; 113: 896-902
- Atrial septal defect closure via ministernotomy in children.Heart Lung Circ. 2021; 30: e98-e100
- Repair of atrial septal defect through a limited right anterolateral thoracotomy in 242 patients: a cosmetic approach.Heart Surg Forum. 2003; 6: E16-E19
- Horizontal right axillary minithoracotomy: aesthetic and effective option for atrial and ventricular septal defect repair in infants and toddlers.Rev Bras Cir Cardiovasc. 2014; 29: 123-130
- Cardiac surgery by transxiphoid approach without sternotomy.Eur J Cardiothorac Surg. 1998; 13: 551-554
- Right posterior-lateral minithoracotomy access for treating congenital heart disease.Ann Thorac Surg. 2011; 92: 2278-2280
- Transaxillary approach for surgical repair of simple congenital cardiac lesions: pitfalls, and complications.World J Pediatr Congenit Heart Surg. 2021; 12: 337-343
- Advantages of a mini right axillary thoracotomy for congenital heart defect repair in children.Cardiol Young. 2022; 32: 276-281
- Right axillary thoracotomy in congenital cardiac surgery: analysis of percutaneous cannulation.Ann Thorac Surg. 2021; 112: 2047-2053
- The right axillary incision: a potential new standard of care for selected congenital heart surgery.Semin Thorac Cardiovasc Surg. 2018; 30: 310-316
- Ventricular septal defects closure using a minimal right vertical infraaxillary thoracotomy: seven-year experience in 274 patients.Ann Thorac Surg. 2010; 89: 552-555
- Evaluation of different minimally invasive techniques in the surgical treatment of atrial septal defect.J Thorac Cardiovasc Surg. 2014; 148: 188-193
- Comparison between minimal right vertical infra-axillary thoracotomy and standard median sternotomy for repair of atrial septal defects.Asian J Surg. 2015; 38: 199-204
- Surgical repair via submammary thoracotomy, right axillary thoracotomy and median sternotomy for ventricular septal defects.J Cardiothorac Surg. 2018; 13: 47
- Mid-term results of right axillary incision for the repair of a wide range of congenital cardiac defects.Eur J Cardiothorac Surg. 2009; 35: 864-870
- Early-and long-term outcomes of cardiovascular surgery via minimal right vertical infra-axillary thoracotomy: a 15-year study of 1,126 patients.Sci Rep. 2018; 8: 4376
Article info
Publication history
Published online: July 20, 2022
Accepted:
June 4,
2022
Received:
March 30,
2022
Identification
Copyright
© 2022 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
