Thoracotomy approach for congenital and acquired heart defects: its possible applications in the current era

From April 1975 to February 1995, 305 patients (260 females and 45 males) underwent open heart surgical procedures through the thoracotomy approach. Their ages ranged from 4 months to 55 years (mean age 21.8 +/- 13 years). Two hundred and ninety-seven patients were operated through the right and eight through the left thoracotomy approach. Two hundred and sixteen patients had congenital heart disease and 89 patients had acquired heart diseases, which included ostium secundum defect (190 patients), sinus venosus defect (11 patients), partial atrioventricular (AV) canal defect (5 patients), complete AV canal (1 patient), ventricular septal defect (4 patients), Tetralogy of Fallot (3 patients), anomalous origin of left coronary artery from pulmonary artery (3 patients), mitral valve lesions (83 patients), including tricuspid valve lesions (5 patients) and coronary artery disease (2 patients). Postoperative recovery was observed to be faster (mean hospital stay 7.8 days vs mid-sternotomy 9.6 days), infection rate lower (0.35% vs median sternotomy 2.56%), postoperative drainage lower (148.8 +/- 86.2 mL vs median sternotomy 587 +/- 112.6 mL), and cosmetically found to be much more acceptable in the female population. There have been seven early and one late postoperative deaths which were unrelated to the operative approach. We conclude from this experience that thoracotomy can be safely used as an access for a wide variety of open cardiac surgical operations on the atrial and (upper) ventricular septae, AV valves, right ventricular outflow tract, and coronary artery reconstruction in some situations. It is also useful in some emergency and redo operations with distinct advantages over the median sternotomy approach. We feel its use should be increased as newer subsets of patient populations are being subjected to primary and redo cardiac operations.