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Updated: Jan 13, 2026

Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
Published on: March 26, 2018
Minimally Invasive Repair of Sinus Venosus Atrial Septal Defects and Anomalous Pulmonary Venous Connections via
Sameh M Said1,2,3, Ali H Mashadi1, Yasin Essa1
1Division of Pediatric and Adult Congenital Cardiac Surgery, Maria Fareri Children's Hospital, Westchester Medical Center, New York Medical College, Valhalla, NY 10595, USA.
Insights
The vertical right axillary thoracotomy is a safe and effective minimally invasive approach for repairing anomalous pulmonary venous connections in children. This technique offers cosmetic benefits and shorter hospital stays.
Area of Science:
- Pediatric Cardiac Surgery
- Minimally Invasive Cardiac Surgery
- Congenital Heart Disease Repair
Background:
- Increasing use of minimally invasive vertical right axillary thoracotomy for pediatric congenital heart defects.
- Need to evaluate outcomes for anomalous pulmonary venous connections (APVC) repair using this approach.
Purpose of the Study:
- To assess the efficacy and safety of vertical right axillary thoracotomy in repairing APVC, with or without sinus venosus defects.
Main Methods:
- Retrospective analysis of 23 pediatric patients undergoing APVC repair.
- Data collected included perioperative details and clinical follow-up.
- Surgical techniques included single patch, Warden, and two-patch repairs.
Main Results:
- No conversions to sternotomy; all patients extubated in OR.
- Median hospital stay of 2 days; no mortalities or reoperations for obstruction.
- Successful repair of partial APVC, scimitar syndrome, and total APVC.
Conclusions:
- Vertical right axillary thoracotomy is a viable option for APVC repair in children.
- The approach accommodates various repair techniques safely.
- Cosmetic advantages and reduced hospital stay support its consideration.
Abstract:
(1) Background: There has been an increase in the utilization of the minimally invasive vertical right axillary thoracotomy approach for repairing congenital heart defects in children recently. We aim, in the current study, to evaluate the outcomes of this approach in repairing anomalous pulmonary venous connections with or without an associated sinus venosus defect. (2) Methods: A total of 23 consecutive patients underwent surgical repair of anomalous pulmonary venous connections between April 2018 and February 2024. Perioperative and clinical follow-up data were obtained. (3) Results: The median age and weight were 36 months (1-277 months) and 14.4 kg (3.6-79.4 kg), respectively. More than half were females (13; 56.5%). There was no conversion to sternotomy. Partial anomalous pulmonary venous connections were the most frequent primary diagnoses (14; 60.9%), followed by scimitar syndrome (3; 13%), while two patients (8.7%) had total anomalous pulmonary venous connections. Repair techniques included single patch in 10 patients (43.5%), Warden in 6 (26.1%), and two-patch technique in 4 (17.4%). The median cardiopulmonary bypass and aortic cross-clamp times were 91 and 62 min, respectively. All patients were extubated in the operating room. The median length of hospital stay was 2 days. There were no mortalities or reoperations for pulmonary/systemic venous pathway obstruction. (4) Conclusions: Vertical right axillary thoracotomy is a valuable approach for repairing anomalous pulmonary venous connections with or without sinus venosus defects. All repair techniques, including Warden and scimitar, can be performed safely through this approach. The cosmetic superiority and short hospital stay make this approach worth considering.
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