Repair of partial atrioventricular septal defect through a modified right vertical infra-axillary thoracotomy: a
Heqi Zhang1, Zehua Shao2, Haoju Dong1
1Department of Children's Heart Center, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, Henan, China.
Background:
The right vertical infra-axillary thoracotomy (RVIAT) approach has become an established surgical technique for common congenital heart diseases. In recent years, the traditional RVIAT approach has been refined by incorporating thoracoscopic concepts and techniques, resulting in the development of a modified RVIAT (MRVIAT) technique. This single-center observational study aimed to evaluate the clinical outcomes and surgical feasibility of MRVIAT for the repair of partial atrioventricular septal defect (PAVSD).
Methods:
A retrospective analysis was conducted to assess the perioperative outcomes of patients who underwent PAVSD repair using the MRVIAT technique. All procedures were completed through a single 2-5 cm incision under central cardiopulmonary bypass.
Results:
All 64 patients underwent successful repair without conversion to median sternotomy. No mortality or major complications were observed. The mean age was 12.8 ± 16.5 years (range, 0.3-63 years). The median body weight was 55.8 kg (range, 4.2-101.4 kg). The mean operative time was 177.0 ± 46.4 min. The mean cardiopulmonary bypass time was 98.2 ± 34.4 min, and the mean aortic cross-clamp time was 64.5 ± 23.1 min. One patient required reoperation due to patch dehiscence at the atrioventricular valve repair site. A sequential analysis of operative time demonstrated an overall downward trend with increasing case experience, suggesting the presence of a learning curve. During follow-up, no moderate or severe valvular regurgitation was detected, and cardiac function remained within normal limits in all patients.
Conclusion:
The MRVIAT technique appears to be a safe and effective approach for the repair of PAVSD across a wide age spectrum, from infancy to adulthood. The concealed incision offers favorable cosmetic outcomes and may improve patient satisfaction.
