Hostname: page-component-5d59c44645-kw98b Total loading time: 0 Render date: 2024-03-02T21:10:15.382Z Has data issue: false hasContentIssue false

Advantages of a mini right axillary thoracotomy for congenital heart defect repair in children

Part of: Surgery

Published online by Cambridge University Press:  21 May 2021

Jannika Dodge-Khatami
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, Southshore University Hospital, Bay Shore, USA
Ali Dodge-Khatami*
Affiliation:
Department of Cardiothoracic Surgery, Division of Pediatric and Congenital Heart Surgery, Cohen Children’s Medical Center, New Hyde Park, USA
*
Author for correspondence: Ali Dodge-Khatami, MD, PhD, Department of Cardiothoracic Surgery, Division of Pediatric and Congenital Heart Surgery, Cohen Children’s Medical Center, 1111 Marcus Avenue, Suite M15, New Hyde Park, NY 11042, USA. Tel: 1 (601) 918-4758; Fax: 1 (516) 601-7380. E-mail: adodgekhatami@gmail.com

Abstract

Objectives:

The mini right axillary thoracotomy is an alternative surgical approach to repair certain congenital heart defects. Quality-of-life metrics and clinical outcomes in children undergoing either the right axillary approach or median sternotomy were compared.

Methods:

Patients undergoing either approach for the same defects between 2018 and 2020 were included. Demographic details, operative data, and outcomes were compared between both groups. An abbreviated quality of life questionnaire based on the Infant/Toddler/Child Health Questionnaires focused on the patient’s global health, physical activity, and pain/discomfort was administered to all parents/guardians within two post-operative years.

Results:

Eighty-seven infants and children underwent surgical repair (right axillary thoracotomy, n = 54; sternotomy, n = 33) during the study period. There were no mortalities in either group. The right axillary thoracotomy group experienced significantly decreased red blood cell transfusion, intubation, intensive care, and hospital durations, and earlier chest tube removal. Up to 1 month, parents’ perception of their child’s degree and frequency of post-operative pain was significantly less after the right axillary thoracotomy approach. No difference was found in the patient’s global health or physical activity limitations beyond a month between the two groups.

Conclusions:

With the mini right axillary approach, surrogates of faster clinical recovery and hospital discharge were noted, with a significantly less perceived degree and frequency of post-operative pain initially, but without the quality of life differences at last follow-up. While providing obvious cosmetic advantages, the minimally invasive right axillary thoracotomy approach for the surgical repair of certain congenital heart lesions is a safe alternative to median sternotomy.

Type
Original Article
Copyright
© The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Mihalyi, S, Kiraly, L, Prodan, Z, Bodor, G, Tamas, C, Hartyanszky, I. Right subaxillary and posterolateral thoracotomy for open repair of congenital heart defects. Orv Hetil 2005; 146: 299304.Google ScholarPubMed
Prêtre, R, Kadner, A, Dave, HH, Dodge-Khatami, A, Bettex, D, Berger, F. Right axillary incision: a cosmetically superior approach to repair a wide range of congenital cardiac defects. J Thorac Cardiovasc Surg 2005; 130: 277281.CrossRefGoogle ScholarPubMed
Schreiber, C, Bleiziffer, S, Kostolny, M, et al. Minimally invasive midaxillary muscle sparing thoracotomy for atrial septal defect closure in prepubescent patients. Ann Thorac Surg 2005; 80: 673677.CrossRefGoogle ScholarPubMed
Mishaly, D, Ghosh, P, Preisman, S. Minimally invasive congenital cardiac surgery through right anterior mini-thoracotomy approach. Ann Thorac Surg 2008; 85: 831835.CrossRefGoogle Scholar
Dave, HH, Comber, M, Solinger, T, Bettex, D, Dodge-Khatami, A, Prêtre, R. Mid-term results of right axillary incision for the repair of a wide range of congenital cardiac defects. Eur J Cardio-Thorac Surg 2009; 35: 864870.CrossRefGoogle ScholarPubMed
Palma, G, Giordano, R, Russolillo, V, et al. Anterolateral minithoracotomies for the radical correction of congenital heart diseases. Tex Heart Inst J 2009; 36: 575579.Google ScholarPubMed
Ding, C, Wang, C, Dong, A, et al. Anterolateral minithoracotomy versus median sternotomy for the treatment of congenital heart defects: a meta-analysis and systematic review. J Cardiothorac Surg 2012; 7: 4349.CrossRefGoogle ScholarPubMed
Gil-Jaurena, JM, Castillo, R, Gonzalez, M. Complete muscle-sparing technique in axillary closure of atrial septal defects. Asian Cardiovasc Thorac Ann 2013; 21: 756758.CrossRefGoogle ScholarPubMed
da Fonseca da Silva, L, da Silva, JP, et al. Horizontal right axillary minithoracotomy: aesthetic and effective option for atrial and ventricular septal defect repair in infants and toddlers. Rev Bras Cir Cardiovasc 2014; 29: 123130.Google Scholar
Hu, CX, Tan, J, Chen, S, Ding, H, Xu, ZW. Comparison of clinical outcomes and postoperative recovery between two open heart surgeries: minimally invasive right subaxillary vertical thoracomy and traditional median sternotomy. Asian Pacific J Tropical Med 2014; 7: 625629.CrossRefGoogle Scholar
Luo, H, Wang, J, Qiao, C, Zhang, X, Zhang, W, Song, L. Evaluation of different minimally invasive techniques in the surgical treatment of atrial septal defect. J Thorac Cardiovasc Surg 2014; 148: 188193.CrossRefGoogle ScholarPubMed
Yaliniz, H, Topcuoglu, MS, Gocen, U, et al. Comparison between minimal right vertical infra-axillary thoracotomy and standard median sternotomy for repair of atrial septal defects. Asian J Surg 2015; 38: e199e204.CrossRefGoogle ScholarPubMed
Zhang, X, Xing, Q, Wu, Q. Treatment of perimembranous ventricular septal defect in children weighing less than 15 kg: minimally Invasive Periventricular Device Occlusion versus Right Subaxillary Small Incision Surgical repair. Thorac Cardiovasc Surg 2015; 63: 409418.CrossRefGoogle ScholarPubMed
An, G, Zhang, H, Zheng, S, Wang, W, Wu, Q, Xing, Q. Minimally invasive surgical closure for doubly committed subarterial ventricular septal defects through a right subaxillary thoracotomy. Interact Cardiovasc Thorac Surg 2016; 23: 924928.CrossRefGoogle ScholarPubMed
Dodge-Khatami, A, Salazar, JS. Right axillary thoracotomy for transatrial repair of congenital heart defects: VSD, partial AV canal with mitral cleft, PAPVR or Warden, cor triatriatum, and ASD. Oper Tech Thorac Cardiovasc Surg 2016; 20: 384401.CrossRefGoogle Scholar
Gil-Jaurena, JM, Pérez-Caballero, R, Pita-Fernández, A, González-López, MT, Sánchez, J, De Agustín, JC. How to set-up a program of minimally-invasive surgery for congenital heart defects. Transl Pediatr 2016; 5: 125133.CrossRefGoogle ScholarPubMed
An, G, Zhang, H, Zheng, S, Wang, W, Ma, L. Mid-term outcomes of common congenital heart defects corrected through a right subaxillary thoracotomy. Heart Lung Circ 2017; 26: 376382.CrossRefGoogle ScholarPubMed
Garg, P, Bishnoi, AK, Lakhia, K, et al. Cervical cannulation for surgical repair of congenital cardiac defects in infants and small children. Braz J Cardiovasc Surg 2017; 32: 111117.Google ScholarPubMed
Heinisch, PP, Wildbolz, M, Beck, MJ, et al. Vertical right axillary mini-thoracotomy for correction of ventricular septal defects and complete atrioventricular septal defects. Ann Thorac Surg 2018; 106: 12201227.CrossRefGoogle ScholarPubMed
Hong, ZN, Chen, Q, Lin, ZW, et al. Surgical repair via submammary thoracotomy, right axillary thoracotomy and median sternotomy for ventricular septal defects. J Cardiothorac Surg 2018; 13: 4753.CrossRefGoogle ScholarPubMed
Lee, T, Weiss, AJ, Williams, EE, Kiblawi, F, Dong, J, Nguyen, KH. The right axillary incision: a potential new standard of care for selected congenital heart surgery. Semin Thorac Cardiovasc Surg 2018; 30: 310316.CrossRefGoogle ScholarPubMed
Wadhawa, VA, Patel, KG, Doshi, CP, et al. Direct femoral cannulation in minimal invasive pediatric cardiac surgery: our experience with midterm result. Ann Thorac Surg 2018; 13: 300304.Google ScholarPubMed
Wang, Q, Ye, JX, Ge, M, Wang, DJ. Early- and long-term outcomes of cardiovascular surgery via minimal right vertical infra-axillary thoracotomy: a 15-year study of 1,126 patients. Sci Rep 2018; 8: 43764382.CrossRefGoogle ScholarPubMed
Liu, R, Rui, L, Zhang, B, Lin, Y, Li, S, Hua, Z. Through Tricuspid closure for doubly committed subarterial ventricular septal defect with right vertical subaxillary mini-incision: a matched-pair analysis. Pediatr Cardiol 2019; 40: 12471252.CrossRefGoogle ScholarPubMed
Dixit, S, Sharma, A, Suthar, J, Watti, V, Sharma, M. Repair of ventricular septal defect through anterolateral thoracotomy with central cannulation: our experience. Indian J Thorac Cardiovasc Surg 2020; 36: 476482.CrossRefGoogle Scholar
Luo, ZR, Chen, Q, Yu, LL, Chen, LW, Huang, ZY. Comparative study between surgical repair of atrial septal defect via median sternotomy, right submammary thoracotomy, and right vertical infra-axillary thoracotomy. Braz J Cardiovasc Surg 2020; 35: 285290.CrossRefGoogle ScholarPubMed
Heinisch, PP, Bartkevics, M, Beck, MJ, et al. Right axillary thoracotomy in congenital cardiac surgery: analysis of percutaneous cannulation. Ann Thorac Surg 2020; S0003-4975(20)31855-5. doi: 10.1016/j.athoracsur.2020.10.011.CrossRefGoogle Scholar
Mavroudis, C, Backer, CL, Stewart, R, Heraty, P. The case against minimally invasive cardiac surgery. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2005; 193197.CrossRefGoogle Scholar
Kara, KA, Caner, T. Comparison of pain in the early post-operative period using VAS score in patients after cardiac surgery who had minimally invasive incisions vs. full median sternotomy. Ann Ital Chir 2019; 90: 39.Google ScholarPubMed
Dodge-Khatami, J, Adebo, DA. Evaluation of complex congenital heart disease in infants using low dose cardiac computed tomography. Int J Cardiovasc Imaging 2021; 37: 14551460.CrossRefGoogle ScholarPubMed