Right Axillary Straight Mini-thoracotomy in Open Heart Surgery in Infants_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 LIBao-jun , MENGDong-liang , SUNZhi-gang , CHAIWen-xiang , LIUGao-feng , ZHONGHou-cheng , DINGXiao-yong , ZHANGPeng

Department of cardio-thoracic Surgery, The 153 ^rd Central Hospital of People's Liberation Army, Zhengzhou 450042, P. R. China;

Corresponding author：

LIBao-jun, Email: lbj153yy@163.com

Keywords：

Right axillary minithoracotomy; Congenital heart disease; Open heart surgery; Infant

DOI：

10.7507/1007-4848.20140182

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Objective To summarize our experience of right axillary straight mini-thoracotomy for surgical treatment of common congenital heart diseases in infants. Methods We conducted a retrospective analysis of 369 infants undergoing open heart surgery through right axillary straight mini-thoracotomy in the 153th Central Hospital of People's Liberation Army from April 2009 to April 2013. There were 191 males and 178 females with their mean age of 8.2±3.1 months (range, 3-12 months)and body weight of 7.8±4.5 kg (rang, 4.5-11.2 kg). Surgical procedures included ventricular septal defect (VSD)repair in 290 patients, atrial septal defect (ASD)repair in 16 patients, VSD and ASD repair in 34 patients, VSD repair and mitral valvuloplasty in 4 patients, valvotomy for pulmonary valve stenosis (PVS)in 9 patients, ASD repair and valvotomy for PVS in 6 patients, correction of partial anomalous pulmonary venous connection in 4 patients, and correction of partial atrioventricular canal defect in 6 patients. Results Six patients (1.6%)died postoperatively. Postoperative complications included right atelectasis in 3 patients, right pneumothorax in 2 patients, pneumonia in 16 patients, incision fat liquefaction in 12 patients, third-degree atrioventricular block in 1 patient, cerebral air embolism in 1 patient, and reexploration for bleeding in 3 patients. A total of 295 patients were followed up for 6 to 12 months after discharge. Residual VSD shunt was found in 4 patients, and mild mitral regurgitation was found in 2 patients. Conclusion Clinical outcomes of right axillary straight mini-thoracotomy during open heart surgery are satisfactory for infants with common congenital heart diseases, but strict indications and skillful surgical techniques are needed.

Citation： LIBao-jun, MENGDong-liang, SUNZhi-gang, CHAIWen-xiang, LIUGao-feng, ZHONGHou-cheng, DINGXiao-yong, ZHANGPeng. Right Axillary Straight Mini-thoracotomy in Open Heart Surgery in Infants. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(5): 640-642. doi: 10.7507/1007-4848.20140182 Copy

1.	Abdel-Rahman U, Wimmer-Greinecker G, Matheis G, et al. Correction of simple congenital heart defects in infants and children through a minithoracotomy. Ann Thorac Surg, 2001, 72(5):1645-1649.
2.	苏肇伉.先天性心脏病微创手术的发展趋势.中国胸心血管外科临床杂志, 2005, 12(4):229-231.
3.	del Nido PJ. Minimal incision congenital cardiac surgery. Semin Thorac Cardiovasc Surg, 2007, 19(4):319-324.
4.	胡盛寿, 张浩.微创心脏外科学的概念和发展.中国微创外科杂志, 2006, 6(6):404-406.
5.	Nguyen K, Chin C, Lee DS, et al. The axillary incision:a cosmetic approach in congenital cardiac surgery. J Thorac Cardiovasc Surg, 2007, 134(5):1358-1360.
6.	易定华, 徐学增.小儿全胸腔镜心脏外科研究现状及前景.解放军医学杂志, 2007, 32(9):897-898.
7.	张玉展, 李红昕, 邹承伟, 等.经胸骨旁途径嵴内型嵴上型室间隔缺损微创封堵术.中华胸心血管外科杂志, 2013, 29(1):8-11.
8.	杨明, 高长青.机器人心脏手术的应用现状.中国微创外科杂志, 2012, 12(7):586-593.
9.	冯晓东, 张勇, 王学斌, 等.腋下直切口在体外循环心脏直视手术中的应用:附612例报告.中国微创外科杂志, 2009, 9(7):632-634.
10.	何发明, 王平凡, 梁志强, 等.右腋下小切口心脏直视手术3012例的临床应用.中国胸心血管外科临床杂志, 2010, 17(3):247-249.
11.	王东进, 吴清玉, 杨秀滨, 等.右腋下直切口在体外循环心脏直视手术中的应用.中国胸心血管外科临床杂志, 2007, 14(6):468-470.
12.	乔衍礼, 安国营, 张洪宇, 等.右腋下小切口体外循环心内直视手术270例.中国胸心血管外科临床杂志, 2012, 19(5):565-566.
13.	Tiveron MG, Fiore AI, Mota EM, et al. Preoperative risk factors for mediastinitis after cardiac surgery:analysis of 2768 patients. Rev Bras Cir Cardiovasc, 2012, 27(2):203-210.
14.	Vida VL, Ma PO, Boccuzzo G, et al. Minimally invasive operation for congenital heart disease:a sex-differentiated approach. J Thorac Cardiovasc Surg, 2009, 138(4):933-936.
15.	李建荣, 刘迎龙, 于存涛, 等.右外侧小切口室间隔缺损修补术疗效及生活质量研究.中国微创外科杂志, 2009, 9(5):399-403.
16.	Gil-Jaurena JM, Ji ZL, Conejo L, et al. Minimally invasive pediatric cardiac surgery. Atrial septal defect closure through axillary and submammary approaches. Rev Esp Cardio, 2011, 64(3):208-212.
17.	Dave HH, Comber M, Solinger T, et al. Mid-term results of right axillary incision for the repair of a wide range of congenital cardiac defects. Eur J Cardiothorac Surg, 2009, 35(5):864-869.
18.	胡义杰, 钟前进, 陈建明, 等.右侧腋下小切口先天性心脏病直视手术的临床应用.中国胸心血管外科临床杂志, 2012, 19(4):427-429.

1. Abdel-Rahman U, Wimmer-Greinecker G, Matheis G, et al. Correction of simple congenital heart defects in infants and children through a minithoracotomy. Ann Thorac Surg, 2001, 72(5):1645-1649.
2. 苏肇伉.先天性心脏病微创手术的发展趋势.中国胸心血管外科临床杂志, 2005, 12(4):229-231.
3. del Nido PJ. Minimal incision congenital cardiac surgery. Semin Thorac Cardiovasc Surg, 2007, 19(4):319-324.
4. 胡盛寿, 张浩.微创心脏外科学的概念和发展.中国微创外科杂志, 2006, 6(6):404-406.
5. Nguyen K, Chin C, Lee DS, et al. The axillary incision:a cosmetic approach in congenital cardiac surgery. J Thorac Cardiovasc Surg, 2007, 134(5):1358-1360.
6. 易定华, 徐学增.小儿全胸腔镜心脏外科研究现状及前景.解放军医学杂志, 2007, 32(9):897-898.
7. 张玉展, 李红昕, 邹承伟, 等.经胸骨旁途径嵴内型嵴上型室间隔缺损微创封堵术.中华胸心血管外科杂志, 2013, 29(1):8-11.
8. 杨明, 高长青.机器人心脏手术的应用现状.中国微创外科杂志, 2012, 12(7):586-593.
9. 冯晓东, 张勇, 王学斌, 等.腋下直切口在体外循环心脏直视手术中的应用:附612例报告.中国微创外科杂志, 2009, 9(7):632-634.
10. 何发明, 王平凡, 梁志强, 等.右腋下小切口心脏直视手术3012例的临床应用.中国胸心血管外科临床杂志, 2010, 17(3):247-249.
11. 王东进, 吴清玉, 杨秀滨, 等.右腋下直切口在体外循环心脏直视手术中的应用.中国胸心血管外科临床杂志, 2007, 14(6):468-470.
12. 乔衍礼, 安国营, 张洪宇, 等.右腋下小切口体外循环心内直视手术270例.中国胸心血管外科临床杂志, 2012, 19(5):565-566.
13. Tiveron MG, Fiore AI, Mota EM, et al. Preoperative risk factors for mediastinitis after cardiac surgery:analysis of 2768 patients. Rev Bras Cir Cardiovasc, 2012, 27(2):203-210.
14. Vida VL, Ma PO, Boccuzzo G, et al. Minimally invasive operation for congenital heart disease:a sex-differentiated approach. J Thorac Cardiovasc Surg, 2009, 138(4):933-936.
15. 李建荣, 刘迎龙, 于存涛, 等.右外侧小切口室间隔缺损修补术疗效及生活质量研究.中国微创外科杂志, 2009, 9(5):399-403.
16. Gil-Jaurena JM, Ji ZL, Conejo L, et al. Minimally invasive pediatric cardiac surgery. Atrial septal defect closure through axillary and submammary approaches. Rev Esp Cardio, 2011, 64(3):208-212.
17. Dave HH, Comber M, Solinger T, et al. Mid-term results of right axillary incision for the repair of a wide range of congenital cardiac defects. Eur J Cardiothorac Surg, 2009, 35(5):864-869.
18. 胡义杰, 钟前进, 陈建明, 等.右侧腋下小切口先天性心脏病直视手术的临床应用.中国胸心血管外科临床杂志, 2012, 19(4):427-429.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Right Axillary Straight Mini-thoracotomy in Open Heart Surgery in Infants

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