Minimally Invasive Surgical Repair of Simple Congenital Heart Defects Using the Right Vertical Infra-Axillary Thoracotomy Approach

• Published in: Innovations (Philadelphia, Pa.) Pa.), 2024-09, Vol.19 (5), p.520-525
• Main Authors: Tran, Dien Minh, Tran, Vinh Quang, Nguyen, Mai Tuan, Mai, Duyen Dinh, Doan, Anh Vuong, Hoang, Son Thanh, Kotani, Yasuhiro, Nguyen, Truong Ly-Thinh
• Format: Article
• Language: English
• Subjects: Axilla - surgery; Cardiac Surgical Procedures - methods; Child, Preschool; Female; Heart Defects, Congenital - surgery; Humans; Infant; Male; Minimally Invasive Surgical Procedures - methods; Operative Time; Postoperative Complications - epidemiology; Retrospective Studies; Thoracotomy - methods; Treatment Outcome
• ISSN: 1556-9845; 1559-0879; 1559-0879
• DOI: 10.1177/15569845241273650

Objective: To evaluate the safety and efficacy of surgical repair for patients diagnosed with simple congenital heart defects (CHD) using the minimally invasive right vertical infra-axillary minithoracotomy (RVIAT) approach. Methods: We retrospectively reviewed the clinical data of consecutive patients who underwent minimally invasive RVIAT for repair of CHD between August 2019 and August 2022. There were 382 patients who underwent 8 primary procedures and were included in this study. Results: The median age of the patients was 16.2 (interquartile range [IQR], 7.2 to 41.9) months, and the median weight of the patients was 8.8 (IQR, 6.5 to 14) kg. The preoperative diagnoses were as follows: ventricular septal defect, atrial septal defect, partial anomalous pulmonary venous return, partial atrioventricular septal defect, cor triatriatum, complete atrioventricular septal defect, and myxoma. The mean aortic cross-clamp time, bypass time, and operation time were 45.4 ± 19.3 min, 65.6 ± 23.1 min, and 154.5 ± 29.7 min, respectively. There was no in-hospital mortality or conversion to median sternotomy. Two patients (0.5%) required early reoperation; 1 due to postoperative bleeding and 1 for permanent pacemaker implantation. Other complications included trivial residual shunts (23 of 382, 6%), pleural effusion (3 of 382, 0.8%), pneumothorax (0.8%), and wound infection (4 of 382, 1%). There were 2 late noncardiac deaths. Late reoperation was performed on 1 patient with progressive aortic valve regurgitation who required aortic valvuloplasty. Conclusions: RVIAT is a minimally invasive approach that can be safely performed on patients with simple CHDs. RVIAT may be a good alternative approach for median sternotomy and cardiac intervention. Visual abstract