Vertical Right Axillary Thoracotomy for Repair of Ventricular Septal Defects in Infants and Children: Experience with...

Area of Science:

• Pediatric Cardiac Surgery
• Minimally Invasive Cardiac Surgery
• Congenital Heart Defect Repair

Background:

• Growing interest in minimally invasive techniques for congenital heart defect repair in children.
• Right axillary thoracotomy is emerging as a viable alternative to traditional sternotomy for pediatric cardiac procedures.

Purpose of the Study:

• To review the clinical experience and outcomes of ventricular septal defect (VSD) closure using the right axillary thoracotomy approach in pediatric patients.
• To evaluate the safety, efficacy, and cosmetic benefits of this minimally invasive technique compared to sternotomy.

Main Methods:

• Retrospective single-center analysis of 50 children undergoing VSD closure via vertical right axillary thoracotomy.
• Data collected included patient demographics, perioperative details (cardiopulmonary bypass time, aortic cross-clamp time), and follow-up outcomes.
• All procedures were performed without conversion to sternotomy.

Main Results:

• The study included 50 children (52% female) with a median age of 7 months.
• Membranous VSD was the most common type (89%). Median cardiopulmonary bypass and cross-clamp times were 96.5 and 73 minutes, respectively.
• No mortality was observed. All patients were extubated in the OR, with a median hospital stay of 2 days. One early reoperation for bleeding and one patient required a permanent pacemaker. Patients and parents reported high satisfaction with the incision.

Conclusions:

• Right axillary thoracotomy is a safe and effective approach for pediatric VSD repair, demonstrating excellent clinical outcomes.
• The technique is associated with superior cosmetic results and significantly shorter hospital stays compared to sternotomy.
• This minimally invasive approach should be strongly considered as an alternative to sternotomy for VSD closure in children.