NYMC Faculty Publications

Right Axillary Thoracotomy vs. Median Sternotomy for Repair of Congenital Heart Defects in Infants and Children

Author Type(s)

Faculty

DOI

10.32604/chd.2025.061819

Journal Title

Congenital Heart Disease

First Page

563

Last Page

575

Document Type

Article

Publication Date

1-1-2024

Department

Surgery

Keywords

axillary thoracotomy, congenital heart defects, Minimally invasive cardiac surgery, right thoracotomy, vertical axillary right thoracotomy

Disciplines

Medicine and Health Sciences

Abstract

Objective: Vertical right thoracotomy (VRAT) has become an alternative to sternotomy for the repair of non-complex congenital heart defects in our infants and children. Summary Background Data: Limited data exists on the comparison of the two approaches. Methods: The present study consisted of two groups; Group I: (sternotomy; 33 patients) and Group II: (VRAT; 35 patients). We compared the two groups on operative data, hours of invasive lines, narcotics used, length of stay, and total variable cost of stay. Results: The most frequent procedures were atrial and ventricular septal defect closure (25 patients, 75.8% in Group I) and (14 patients, 40% in Group II). The average age and weight were 33.43 ± 53 months, and 14.7 ± 16.9 kg for Group I, and 75.3 ± 60.2 months and 24.9 ± 18 kg for Group II, respectively, (p < 0.001). We found no differences in aortic cross-clamp/bypass times between groups (p = 0.39 and 0.42, respectively). The use of narcotics was not significantly different between the two study groups (p = 0.37) as was the total variable cost (p = 0.115). Group II had a lower time without invasive lines (p < 0.001). In Group II the total length of stay was significantly less as well (p < 0.001). Conclusions: VRAT is a useful technique for repairing a wide range of heart defects and does not result in prolonged cardiopulmonary bypass or aortic cross-clamp times. Although total opioid use and total cost of stay are no different as with sternotomy, the shortened duration of invasive line use, and shorter length of stay make this approach worthy of consideration.

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