Modified Right Vertical Infra-Axillary Thoracotomy: 2-5 cm Incision Approach for Repair Doubly Committed Subarterial...

This study aims to assess the safety, feasibility, and short-term outcomes of a modified right vertical infra-axillary thoracotomy (MRVIAT) technique, using a 2-5 cm incision without peripheral cannulation in patients of all ages with doubly committed subarterial ventricular septal defects (DCVSDs) and summarise associated surgical techniques.

A retrospective review was performed on 171 patients with DCVSDs of all ages who underwent the MRVIAT procedure between 2022 and 2024.

The procedure was successfully completed in all 171 patients without conversion to median sternotomy or in-hospital mortality. The median age was 1.3 years (range, 0.1-39.0 years), with seven patients (4.1%) aged ≥18 years. The median weight was 10.2 kg (range, 3.8-86.6 kg). Among them, nine patients (5.3%) weighed ≤5 kg, 83 (48.5%) weighed ≤10 kg, 81 (47.4%) weighed 10-50 kg, and seven (4.1%) weighed ≥50 kg. Complications included mild residual shunting in two cases (1.2%), incision infection in one case (0.6%), and pulmonary infection in one case (0.6%). Over a median follow-up of 1.3 years (range, 0.3-2.5 years), no thoracic deformities or moderate-to-severe valvular regurgitation were observed.

The MRVIAT technique is a safe and viable option for the surgical treatment of DCVSD in patients across all age groups. It provides a minimally invasive approach with a small, inconspicuous incision and avoids peripheral cannulation, making it a promising alternative to median sternotomy.