Mid-term Outcomes of Common Congenital Heart Defects Corrected Through a Right Subaxillary Thoracotomy

Abstract

Objective: To evaluate the mid-term outcomes of the correction of various congenital heart defects through a right subaxillary thoracotomy.

Methods: Between June 2004 and April 2014, all eligible patients were those with a common congenital heart defect corrected via an approach through a right subaxillary thoracotomy. There were 836 patients (male 417, female 419; median age, 3.5 years; median weight 13.6kg) with ventricular septal defect (VSD) closure (523 patients), atrial septal defect (ASD) closure (235 patients), partial atrioventricular canal (PAVC) correction (55 patients), mild tetralogy of Fallot (TOF) (23 patients). Additional procedures involved tricuspid valvuloplasty (TVP) (68 patients), repair of partial anomalous pulmonary venous connection (PAPVC) (54 patients), mitral annuloplasty (42 patients), closure of patent ductus arteriosus (PDA) (35 patients), correction of cor triatriatum (eight patients). The median cardiopulmonary bypass (CPB) and aortic cross-clamp times were 67 (28∼217) and 23 (3∼116) min, respectively.

Results: The procedures were performed successfully in all patients, and no in-hospital mortality occurred. There was no need for conversion to another approach in all procedures. The main complications involved arrhythmia in 21 patients, atelectasis in 18, pneumothorax in 17, subcutaneous emphysema in 15, pulmonary infection in 14, low cardiac output syndrome in eight, transient cerebral dysfunction in two. The patients were all in excellent condition after a mean follow-up of 34 months. The cardiac defect was repaired with no residual defect in 820 patients and with trivial to mild residual defect in 16 patients (10 with small VSD residual shunt, four with mild mitral regurgitation, two with mild residual right ventricular outflow tract obstruction). The incision healed properly in all, and the thorax showed no deformity.

Conclusions: Right subaxillary thoracotomy, providing an advantageous alternative, can be performed with favourable cosmetic and satisfactory clinical results for the correction of a wide range of common congenital heart defects.

Keywords: Congenital heart defect; Minimally invasive cardiac surgery; Right subaxillary thoracotomy.