Minimally invasive congenital cardiac surgery via right subaxillary thoracotomy single center experience

Abstract

Background: Congenital heart defects (CHDs) affect 8-10 per 1,000 live births. Traditional median sternotomy is commonly used but has drawbacks such as large scars, prolonged recovery, and increased postoperative complications. Minimally invasive surgery (MIS), particularly right axillary thoracotomy, has emerged as a promising alternative. This study aims to evaluate the short-term outcomes of this approach.

Methods: A retrospective study was conducted on patients who underwent minimally invasive congenital heart surgery via right axillary thoracotomy at the University Medical Center in Ho Chi Minh City from January 2023 to December 2024. Patients with complete medical records and eligible CHD diagnoses were included, while complex cases and those with incomplete documentation were excluded. Demographics, intraoperative parameters, and postoperative outcomes were analyzed.

Results: Among 92 patients, the median age was 9 months, and the median weight was 7 kg. Ventricular septal defect repair was the most common procedure (82.6%), followed by atrial septal defect repair (4.3%) and tetralogy of Fallot repair (6.5%). No cases required conversion to sternotomy, and there was no mortality. The median cardiopulmonary bypass time was 105 ± 28 minutes, the median aortic cross-clamp time was 69 ± 23 minutes, the median ventilation time was 7 hours, and the median ICU stay was 2 days. The complication rate was very low.

Conclusion: Short-term results indicate that right axillary thoracotomy is a feasible and effective approach for CHD repair, offering high success rates, minimal complications, and faster recovery. Further long-term studies are needed to assess its broader clinical implications.