The early results of minimally invasive surgery throught the right axillary approach for the treatment of ventricular septal defect in childrent under 6 months old

Abstract

Objective: this study to evaluate the characteristics of the lesions as well as the early results of minimally invasive surgery through the right axillary approach for the treatment of ventricular septal defect in children under 6 months old

Summary: Ventricular septal defect is the most common congenital heart disease, accounting for about 25%. Surgical repair is indicated when the patient has symptoms of heart failure, poor weight gain or recurrent pneumonia; echocardiography demonstrates a large defect or one located in a position that cannot be self-closed (below the aortic valve, infundibular position). Nowadays, with the development of anesthesia and surgical techniques, most ventricular septal defects are surgically treated through minimally invasive procedures. However, in children under 6 months of age, especially newborns with low birth weight, minimally invasive surgery in the treatment of ventricular septal defects is still a challenge in clinical practice. We conducted this study to evaluate the characteristics of the lesions as well as the early results of minimally invasive surgery through the right axillary approach for the treatment of ventricular septal defect in children under 6 months old at the Cardiovascular Center - E Hospital in the period of 2022 - 2023.

Study subjects and methods: descriptive study. From October 2022 to December 2023, 62 patients who were under 6 months of age with ventricular septal defect underwent minimally invasive surgery through the right axillary approach, 27 males and 35 females, average age 3 months, average weight 4.8 kg. The average diameter was 7.4 mm, severe pulmonary hypertension in 27 patients (42.9%). Results: average CPB and cross-clamping aortic time were 68 minutes and 46 minutes, respectively . No patient required sternotomy. Average ventilator time was 30 hours, hospital stay was 15 days. No incidence of fatality. Early postoperative complications included: temporary arrhythmia (4 patients), postoperative bleeding (1 patient), cerebrovascular accident (2 patients), superior vena cava stenosis (1 patient), diaphragmatic paralysis (1 patient), chylous effusion (1 patient). Postoperative echocardiography: closed ventricular septal defect in 55 patients (88.7%), residual permeable shunt in 7 patients with small residual shunt with out reoperation. Postoperative pulmonary hypertension decreased or disappeared in most patients, only 1 patient still had severe postoperative pulmonary hypertension. Conclusion: minimally invasive surgery via the right axillary approach to treat ventricular septal defect in children under 6 months of age is feasible and brings positive early results.