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Mini right axillary thoracotomy for congenital heart defect repair can become a safe surgical routine

Part of: Surgery

Published online by Cambridge University Press:  18 February 2022

Jannika Dodge-Khatami ,
Rabia Noor ,
Kyle W. Riggs  and
Ali Dodge-Khatami Open the ORCID record for Ali Dodge-Khatami [Opens in a new window]
Jannika Dodge-Khatami
Affiliation:
Division of Pediatric Cardiology, Southshore University Hospital, Bay Shore, NY, USA
Rabia Noor
Affiliation:
Division of Pediatric Cardiology, University of Mississippi Medical Center, Jackson, MS, USA
Kyle W. Riggs
Affiliation:
Department of Cardiovascular and Thoracic Surgery, Northwell Health, Manhassett, NY, USA
Ali Dodge-Khatami*
Affiliation:
Novick Cardiac Alliance, Memphis, TN, USA
*
Author for correspondence: A. Dodge-Khatami, MD, PhD, Pediatric & Congenital Heart Surgeon, Novick Cardiac Alliance, 1750 Madison Ave, Suite 500, Memphis, TN 38104, USA. Tel:1 (901) 302-9500. E-mail: adodgekhatami@gmail.com
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Abstract

Objective:

Owing to its obvious cosmetic appeal, minimal invasive repair of congenital heart defects (CHDs) through the mini right axillary thoracotomy is becoming routine in many centres. Besides cosmesis, and before becoming a new norm, it is important to establish its outcomes as safe compared to repairs through traditional median sternotomy.

Methods:

Between 2013 and 2021, 116 consecutive patients underwent defect repairs through mini right axillary thoracotomy. Patient, operative data, and hospital outcomes were compared to contemporary mini right axillary thoracotomy and sternotomy series.

Results:

There was no mortality or need for approach conversion (mean age 4.3 years, range 0.17–17, mean weight 18.6 kg, range 4.8–74.4) in 118 repairs for atrial septal defect, ventricular septal defect, partial anomalous pulmonary venous return, partial atrioventricular canal with mitral cleft, scimitar syndrome, double-chambered right ventricle, cor triatriatum, and tricuspid valve repair. Protocol included on-table extubation, achieved in 97 children, with 23 outliers leading to 0.7 average hours of mechanical ventilation (range 0–66 hours), indwelling chest drain time of 2.6 days (range 1–9 days), intensive care stay of 1.8 days (range 1–10 days), and hospital stay of 3.9 days (range 2–18 days). Late revisions were required in one patient after scimitar repair for scimitar vein stenosis at 2 weeks, and in another for repair of superior caval vein stenosis after a Warden operation at 2 months; reoperations (5/116 = 4.3%) were successfully performed through the same mini right axillary incision.

Conclusions:

While providing obvious cosmetic advantages, the minimally invasive right axillary thoracotomy approach for the surgical repair of common CHDs yields excellent results and is safe compared to the benchmark median sternotomy approach.

Keywords

Congenital heart defectsminimal invasive surgery
Type
Original Article
Information
Cardiology in the Young , Volume 33 , Issue 1 , January 2023 , pp. 38 - 41
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Copyright
© The Author(s), 2022. Published by Cambridge University Press

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