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Programme-building aspects with introducing minimally invasive axillary thoracotomy repairs in children
Kamran Musayev1, Kamran Ahmadov1, Ali Dodge-Khatami2
1Department of Cardiovascular Surgery, Merkezi Klinika, Azerbaijan.
Insights
Minimally invasive vertical right axillary thoracotomy is a safe and effective alternative for pediatric congenital heart defect (CHD) repair. Comprehensive team education is crucial for successful outcomes with this approach.
Area of Science:
- Pediatric Cardiac Surgery
- Minimally Invasive Techniques
- Congenital Heart Disease
Background:
- Vertical right axillary thoracotomy offers cosmetic and functional advantages over median sternotomy for pediatric congenital heart defect (CHD) repair.
- Establishing new surgical programs requires careful planning and execution.
Purpose of the Study:
- To report the implementation and outcomes of a minimally invasive vertical right axillary thoracotomy program for pediatric CHD repair.
- To outline the multidisciplinary team-building protocol and challenges encountered.
Main Methods:
- Retrospective review of 152 pediatric patients undergoing CHD repair via vertical right axillary thoracotomy (April 2022 - December 2025).
- Pre-commencement multidisciplinary team training involving surgical site visits, expert exchange, and multimedia education.
Main Results:
- Median patient age: 4.9 years; median weight: 16 kg.
- Short median ICU (1.2 days) and hospital stays (4.6 days).
- Zero in-hospital deaths, conversions to median sternotomy, late deaths, or reoperations during a median 16-month follow-up.
Conclusions:
- Vertical right axillary thoracotomy is a safe and viable approach for diverse pediatric CHDs.
- Thorough team education is essential for achieving excellent outcomes rapidly.
- This technique provides superior cosmetic results and is a strong alternative to median sternotomy.
Introduction:
Minimally invasive vertical right axillary thoracotomy offers an excellent cosmetic and functional alternative to standard median sternotomy for congenital heart repairs in children. We report the steps taken and challenges involved in building an emerging programmes and outcomes in repairing diverse CHDs.
Materials And Methods:
We performed a retrospective review of the first 152 paediatric patients who underwent repair of selected CHDs using the minimal invasive vertical right axillary thoracotomy approach between April 2022 and December 2025 at our institution and outline our multi-disciplinary team-building protocol.
Results:
Pre-commencement protocolar team teaching was implicated 2 months prior to the first case, using information gained through a combination of surgical site visits abroad by the surgeons, protocolar experience exchange with foreign experts, and multimedia educational platforms. The median age was 4.9 years (range: 4 months-13 years), and median weight was 16 kg (6-41 kg). The median lengths of ICU stay and hospital stay were 1.2 and 4.6 days, respectively. No in-hospital deaths or conversions to median sternotomy occurred. No late deaths or reoperations occurred during a median follow-up of 16 months (range 5 months-4 years).
Discussion:
The minimal invasive vertical right axillary thoracotomy can be safely introduced for a broad spectrum of CHDs. Educating all team members is critical to achieving excellent outcomes in a short-time frame. This approach provides excellent cosmetic results with a small "hidden" scar and stands as a good alternative to median sternotomy in selected paediatric patients.
