Axillary thoracotomy versus traditional sternotomy approaches for simple congenital cardiac anomalies in children

This study aims to compare the effectiveness, safety, and outcomes of trans-axillary thoracotomy and full sternotomy for surgical repair of simple congenital cardiac anomalies in children.

A cross-sectional retrospective study was conducted on 90 paediatric patients (aged 2-11 years) treated at Assiut University Heart Hospital between 2010 and 2017. Patients were randomly distributed into trans-axillary thoracotomy and full sternotomy groups. Echocardiography and physical assessments were performed. Operative and postoperative metrics (surgical time, bypass time, intensive care unit (ICU) stay, complications, and analgesic requirements) were collected from medical records and analysed using independent t-tests with statistical significance set at p < 0.05.

Full sternotomy exhibited a shorter operative, bypass, and ischaemic time compared to trans-axillary thoracotomy (p < 0.001). Despite these challenges, trans-axillary thoracotomy had a lower rate of wound complications (11.1% vs. 24.4%) (p = 0.022) and required less postoperative analgesia (p = 0.027), with better pain management and cosmetic results. Trans-axillary thoracotomy was associated with marginally longer ICU (1.40 vs. 1.16 days) and hospital (5.42 vs. 4.13 days) stays postoperatively.

Despite longer surgical times, trans-axillary thoracotomy is a safe and effective minimally invasive alternative to full sternotomy, providing significant cosmetic and recovery benefits. Its successful adoption depends on surgeon expertise and patient selection. Further research should also be aimed at improvements in trans-axillary thoracotomy techniques, leading to reductions in surgical times and longer-term clinical outcomes.