Paul Philipp Heinisch1, Marc Wildbolz2, Maria Julia Beck3, Maris Bartkevics3, Brigitta Gahl3, Balthasar Eberle4, Gabor Erdoes4, Hans-Joerg Jenni3, Florian Schoenhoff3, Jean-Pierre Pfammatter2, Thierry Carrel3, Alexander Kadner3. 1. Centre for Congenital Heart Disease, Department of Cardiovascular Surgery, Inselspital, University Hospital, University Bern, Bern, Switzerland. Electronic address: paulphilipp.heinisch@insel.ch. 2. Centre for Congenital Heart Disease, Department of Cardiology, Inselspital, University Hospital, University Bern, Bern, Switzerland. 3. Centre for Congenital Heart Disease, Department of Cardiovascular Surgery, Inselspital, University Hospital, University Bern, Bern, Switzerland. 4. Department of Anesthesiology and Pain Therapy, Inselspital, University Hospital, University Bern, Bern, Switzerland.
Abstract
BACKGROUND: Vertical right axillary mini-thoracotomy (VRAMT) is the standard approach for correction of atrial septal defect and partial atrioventricular septal defect at our institution. This observational single-center study compares our initial results with the VRAMT approach for the repair of ventricular septal defect (VSD) and complete atrioventricular septal defect (CAVSD) in infants and children to an approach using standard median sternotomy (MS). METHODS: The perioperative courses of patients undergoing VSD and CAVSD correction through either a VRAMT or an MS were analyzed retrospectively. The surgical technique for the VRAMT involved a 4- to 5-cm vertical incision in the right axillary fold. RESULTS: Of 84 patients, 25 (VSD, n = 15; CAVSD, n = 10) underwent correction through a VRAMT approach, whereas 59 (VSD, n = 35; CAVSD, n = 24) had repair through MS. VSD and CAVSD groups were comparable with respect to age and weight. No significant differences were observed for aortic cross-clamp duration, intensive care unit stay, hospital stay, and echocardiographic follow-up. There was no need for any conversion from VRAMT to MS in any case. Neither wound infections nor thoracic deformities were observed in both groups. CONCLUSIONS: VRAMT can be considered as a safe and effective approach for the repair of VSD and CAVSD in selected patient groups, and the outcome data appear comparable to those of MS.
BACKGROUND: Vertical right axillary mini-thoracotomy (VRAMT) is the standard approach for correction of atrial septal defect and partial atrioventricular septal defect at our institution. This observational single-center study compares our initial results with the VRAMT approach for the repair of ventricular septal defect (VSD) and complete atrioventricular septal defect (CAVSD) in infants and children to an approach using standard median sternotomy (MS). METHODS: The perioperative courses of patients undergoing VSD and CAVSD correction through either a VRAMT or an MS were analyzed retrospectively. The surgical technique for the VRAMT involved a 4- to 5-cm vertical incision in the right axillary fold. RESULTS: Of 84 patients, 25 (VSD, n = 15; CAVSD, n = 10) underwent correction through a VRAMT approach, whereas 59 (VSD, n = 35; CAVSD, n = 24) had repair through MS. VSD and CAVSD groups were comparable with respect to age and weight. No significant differences were observed for aortic cross-clamp duration, intensive care unit stay, hospital stay, and echocardiographic follow-up. There was no need for any conversion from VRAMT to MS in any case. Neither wound infections nor thoracic deformities were observed in both groups. CONCLUSIONS: VRAMT can be considered as a safe and effective approach for the repair of VSD and CAVSD in selected patient groups, and the outcome data appear comparable to those of MS.