Ventricular septal defects closure using a minimal right vertical infraaxillary thoracotomy: seven-year experience in 274 patients.
ABSTRACT From December 2001 to February 2008, right vertical infraaxillary thoracotomy (RVIAT) was used to perform ventricular septal defect (VSD) closure in selected patients. This retrospective study reviews our results and experiences.
The study included 274 patients (143 females, 131 males) undergoing VSD closure through a RVIAT approach. Patients were a mean age of 10.5 +/- 8.9 years (range, 0.5 to 43 years). Body weight was 37.8 +/- 12.5 kg (range, 8 to 72 kg). The VSD was subpulmonary in 14 patients and perimembranous in 260.
No perioperative or late deaths occurred during the follow-up. Cardiac defects were corrected in all patients through RVIAT. The mean incision length was 7.2 +/- 2.9 cm (range, 4.1 to 8.9 cm). Cardiopulmonary bypass time was 61.6 +/- 27.8 minutes (range, 29 to 187 minutes), and aortic clamp time was 33.4 +/- 20.8 minutes (range, 5 to 139 minutes). The mean postoperative hospital stay was 4.9 +/- 2.6 days (range, 2 to 14 days). Postoperative echocardiograms revealed 3 patients with residual shunt with later catheter intervention. The cosmetic advantage of the RVIAT is the short incision under the armpit that is often invisible. All patients were satisfied with the cosmetic results during the follow-up.
The RVIAT can be performed with favorable cosmetic and clinical results for VSD closure. It provides a good alternative to standard median sternotomy for VSD patients.
- SourceAvailable from: ats.ctsnetjournals.org[show abstract] [hide abstract]
ABSTRACT: Median sternotomy has been the conventional approach for correction of congenital cardiac defects despite poor cosmetic results at times. Right anterior minithoracotomy was, therefore, assessed as an alternative procedure with a better cosmetic outcome. From October 2002 through February 2007, 75 patients underwent correction of congenital cardiac malformations with the use of cardiopulmonary bypass through right anterior minithoracotomy involving a short incision through the fifth intercostal space and the minimally invasive cannulation. Of them, 18 patients were infants, 42 were children, and 15 were adult. The average age was 9.26 +/- 14.1 years (range, 1.2 to 56). The average weight was 19.59 +/- 24.3 kg (range, 8.5 to 118 kg). The corrected defects included atrial septal defect type II, sinus venosus atrial septal defect with partial anomalous pulmonary venous drainage, atrial component of atrioventricular septal defect, perimembranous ventricular septal defects with patent foramen ovale, mitral valve repair (complex), repair of cleft mitral valve, cor triatum atrial septal defect, repair of double-chambered right ventricle and extraction of atrial septal defect closure device. Skin incisions were as long as 5 cm. There was no operative or late mortality or major morbidity. The mean cardiopulmonary bypass time was 58.67 +/- 35.11 minutes (range, 32 to 263). Sixty-five patients were extubated in the operating room; the remaining 10 patients were extubated within 4 hours. Cosmetic result was very satisfactory in all patients. Two adult patients complained of some right chest musculoskeletal discomfort. The right anterior minithoracotomy incision is a safe and effective alternative to a median sternotomy for correction of congenital heart defects. Cosmetic results are highly satisfactory.The Annals of thoracic surgery 04/2008; 85(3):831-5. · 3.74 Impact Factor
- Journal of Cardiac Surgery - J CARDIAC SURG. 01/2003; 18(3):262-264.
- [show abstract] [hide abstract]
ABSTRACT: Background. In recent years, minimal access cardiac operations have increased in application in both the adult and pediatric population. As our experience has grown with these approaches to atrial septal defect closure, we have expanded the same approach to the repair of more complex congenital heart disease.Methods. At the Children’s Hospital in Boston, from August 1996 to November 1999, a minimal sternotomy approach was used to surgically correct 104 children with congenital heart defects other than atrial septal defect. The approach, in most patients, consisted of a skin incision based over the xiphisternum, 3.5 to 5 cm in length, with division of the xiphoid only and elevation of the sternum by fixed retractor. All patients underwent cannulation for cardiopulmonary bypass through the great vessels in the chest using this same incision. The lesions corrected included ventricular septal defect in 41 patients, tetralogy of Fallot in 27, common atrioventricular canal in 15, mitral valve operation in 3.5, and other defects in 18 patients. There were 53 male and 51 female patients. Mean age at operation was 1.4 years (range, 2 weeks to 11 years).Results. There were no deaths. The mean cardiopulmonary bypass time was 71 minutes (standard deviation, 19 minutes), mean cross-clamp times 40.8 minutes (standard deviation, 13 minutes), and length of stay 4.5 days (standard deviation, 1.9 days). Complications included transient atrioventricular block in 2 patients, pleural effusion requiring drainage in 4, and pericardial effusion in 3 patients. When compared to similar lesions repaired using a full sternotomy approach there was no difference in operating times and length of stay tended to be shorter in the minimal sternotomy group.Conclusions. A minimal sternotomy approach can be used to repair congenital cardiac lesions other than atrial septal defects. It gives good exposure, particularly for transatrial repairs, does not prolong ischemic times, and may lead to shorter hospital stay.The Annals of Thoracic Surgery 03/2001; · 3.45 Impact Factor