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The Influence of Congenital Heart Defect Repair Through a Right Subaxillary Thoracotomy on Postoperative Pulmonary
Xiaonan Wang1, Xiang Li1, Chen He1
1Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, 100029 Beijing, China.
Insights
Right subaxillary thoracotomy (RSAT) for congenital heart defect (CHD) repair in infants shows similar pulmonary function and outcomes compared to standard median sternotomy (SMS). This minimally invasive approach is safe for small infants undergoing VSD or VSD/ASD repair.
Area of Science:
- Pediatric Cardiac Surgery
- Thoracic Surgery
- Congenital Heart Disease Treatment
Background:
- Congenital heart defect (CHD) repair in infants requires careful consideration of surgical approach.
- The impact of right subaxillary thoracotomy (RSAT) versus standard median sternotomy (SMS) on pulmonary function and outcomes in small infants (<5kg, <6 months) is not well-established.
Purpose of the Study:
- To compare the influence of RSAT versus SMS on postoperative pulmonary function and prognosis in infants undergoing ventricular septal defect (VSD) or VSD and atrial septal defect (ASD) repair.
Main Methods:
- Propensity score matching identified 80 infants (<5kg, <6 months) undergoing VSD or VSD/ASD repair.
- 40 infants underwent RSAT, and 40 underwent SMS.
- Perioperative respiratory parameters, morbidity, and mortality were compared between the groups.
Main Results:
- No significant differences in oxygenation index or alveolar-arterial oxygen gradient between RSAT and SMS groups.
- Operating time was significantly shorter in the RSAT group (150 ± 20 min) compared to the SMS group (163 ± 28 min).
- No mortality or significant difference in complication rates was observed between the two surgical approaches.
Conclusions:
- RSAT is a safe and effective alternative to SMS for CHD repair in small infants.
- The RSAT approach does not increase the risk of postoperative respiratory insufficiency and offers comparable outcomes to SMS.
Background:
The influence of repair of congenital heart defect (CHD) via a right subaxillary thoracotomy (RSAT) on postoperative pulmonary function and prognosis in small infants is a key consideration.
Methods:
Data were collected from infants who underwent ventricular septal defect (VSD) repair or VSD and atrial septal defect (ASD) between March 2020 and September 2024. Based on propensity score matching, 80 small infants (weight <5 kg and age <6 months) were selected, of which 40 underwent VSD repair or VSD, and ASD repair through an RSAT, while 40 underwent VSD repair or VSD and ASD repair through a standard median sternotomy (SMS). Perioperative respiratory parameters, morbidity, and mortality were compared to assess the influence of the RSAT approach on pulmonary function and postoperative outcomes in small infants.
Results:
Primary outcome: there were no significant differences (p > 0.05) in the perioperative oxygenation index and alveolar-arterial oxygen gradient between the two surgical approaches. No significant differences were also observed between the two groups in the other respiratory parameters, including peak airway pressure, partial pressure of oxygen, and partial pressure of carbon dioxide. The operating time (150 ± 20 min vs. 163 ± 28 min; p < 0.05) was shorter in the RSAT group compared to the SMS group. There were no deaths in either group. The complication rate was low in both groups, with no significant difference between the groups (p > 0.05).
Conclusion:
Compared with SMS, the RSAT approach for the repair of congenital heart defects does not increase the risk of postoperative respiratory insufficiency and yields comparable outcomes in low-weight small infants.
