Safety and effectivity of right vertical infra-axillary thoracotomy for repair of simple congenital cardiac defects

Abstract

Objective:  To assess the safety and effectivity of right vertical infra-axillary thoracotomy (RVIAT) for the treatment of simple congenital cardiac defects.

Patients and method:  Between June 2022 to August 2022 we performed intracardiac repair for all patients through RVIAT. There were 13 patients, median age 6.4 months (1 - 72) and median weight 5.1 kgs (3 – 25) undergoing repair of atrial septal defect (ASD) (4), ventricular septal defect (VSD) (8), cor triatriatum sinister(1). The surgical technique for the RVIAT involved a 3 to 4-cm vertical incision in the right axillary fold and right plural cavity was entered through fouth intercostal space. Cardio Pulmonary Bypass (CPB) was instituted with aortic and bicaval cannulation and cardioplegic arrest with Custodiol.

Results:  The median CPB and aortic clamp times were 95 minutes(45 - 154) and 57 minutes (15 - 104), respectively. The mean ventilation time resulted in 7,16 hours (2,5 – 38). And postoperative hospital stay in 7,1 days (6 – 13).  There was no conversion to another approach. 1 patient bled after operation . Minor residual defects in 2 patients. No patients had atrioventicular block and phrenic nerve injury after operation. Neither wound infections nor thoracic deformities were observed in this groups.

Conclusion:  RVIAT can be safely performed for repair of simple congenital cardiac defects. Because of its location and the camouflaging effect of being hidden by the resting arm, it has superior cosmetic appeal compared to conventional incisions. It does not interfere with growth of breast tissue, does not cause deformity of the thorax and can be performed with regular instruments and cannulae.