Effect of right vertical infra-axillary thoracotomy on the repair of ventricular septal defect in children_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

REN Lulu , HAO Yajing , CHEN Xiaolong , XIE Yewei , GONG Jin , LI Xiaobing , WANG Beini ,  SHEN Li ,  ZHANG Rufang

Department of Cardiothoracic Surgery, Shanghai Children’s Hospital, Shanghai Jiao Tong University, Shanghai, 200062, P.R.China;

Corresponding author：

SHEN Li, Email: shenli@shchildren.com.cn; ZHANG Rufang, Email: zhangrf@shchildren.com.cn

Keywords：

Right subaxillary vertical incision; ventricular septal defect; age; children; surgical treatment

DOI：

10.7507/1007-4848.201912057

Video：

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Objective To study the safety of right vertical infra-axillary thoracotomy (RVIAT) in the repair of ventricular septal defect (VSD) and the optimal age for RVIAT.Methods Between June 2014 and June 2018, 441 children underwent VSD repair via RVIAT in our hospital. According to the age, they were divided into four groups: a 4 months to 1 year old group (R1 group, n=123), a 1-2 years old group (R2 group, n=106), a 2-5 years old group (R3 group, n=166), a >5 years old group (R4 group, n=46). The clinical effects of the patients were compared.Results All the operations were successfully performed and no serious complication was found in all groups. No statistical difference was observed in the operation time, blood loss during operation, thoracic drainage 24 h after operation among groups (P>0.05). The cardiopulmonary bypass time, aortic cross-blocking time and ICU stay time in the R1 and R2 groups were longer than those in the R3 and R4 groups (P<0.05). In the R1 group, the postoperative ventilating time and postoperative hospital stay time were longer, and the blood transfusion volume was more than those in the R3 and R4 groups (P<0.05). The incidence of postoperative complications was higher in the R4 group than that in the R1 and R3 groups (P<0.05).Conclusion VSD repair via RVIAT may be more effective in children >2 years old, and 2-5 years old may be the optimal age.

Citation： REN Lulu, HAO Yajing, CHEN Xiaolong, XIE Yewei, GONG Jin, LI Xiaobing, WANG Beini, SHEN Li, ZHANG Rufang. Effect of right vertical infra-axillary thoracotomy on the repair of ventricular septal defect in children. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(8): 870-873. doi: 10.7507/1007-4848.201912057 Copy

1.	Hoffman JI. Incidence of congenital heart disease:Ⅰ. Postnatal incidence. Pediatr Cardiol, 1995, 16(3): 103-113.
2.	Sondheimer HM, Rahimi-Alangi K. Current management of ventricular septal defect. Cardiol Young, 2006, 16(Suppl 3): 131-135.
3.	Kogon B, Butler H, Kirshbom P, et al. Closure of symptomatic ventricular septal defects: how early is too early? Pediatr Cardiol, 2008, 29(1): 36-39.
4.	Lillehei CW, Cohen M, Warden HE, et al. The direct-vision intracardiac correction of congenital anomalies by controlled cross circulation; results in thirty-two patients with ventricularseptal defects, tetralogy of Fallot, and atrioventricularis communis defects. Surgery, 1955, 38(1): 11-29.
5.	Braile DM, Evora P. The "rebirth" of the right anterolateral thoracotomy approach in cardiac surgery. Braz J Cardiovasc Surg, 2018, 33(2): Ⅰ-Ⅱ.
6.	Hong ZN, Chen Q, Lin ZW, et al. Surgical repair via submammary thoracotomy, right axillary thoracotomy and median sternotomy for ventricular septal defects. J Cardiothorac Surg, 2018, 13(1): 47.
7.	Schreiber C, Bleiziffer S, Lange R, et al. Midaxillary lateral thoracotomy for closure of atrial septal defects in pre-pubescent female children: reappraisal of an "old technique". Cardiol Young, 2003, 13(6): 565-567.
8.	Bleiziffer S, Schreiber C, Burgkart R, et al. The influence of right anterolateral thoracotomy in prepubescent female patients on late breast development and on the incidence of scoliosis. Thorac Cardiovasc Surg, 2004, 127(5): 1474-1480.
9.	Pretre R, Kadner A, Dave H, et al. Right axillary incision: a cosmetically superior approach to repair a wide range of congenital cardiac defects. Thorac Cardiovasc Surg, 2005, 130(2): 277-281.
10.	An G, Zhang H, Zheng S, et al. Mid-term outcomes of common congenital heart defects corrected through a right subaxillary thoracotomy. Heart Lung Circ, 2017, 26(4): 376-382.
11.	Dodge-Khatami A, Salazar JD. Right axillary thoracotomy for transatrial repair of congenital heart defects: VSD, partial AV canal with mitral cleft, PAPVR/warden, cor triatriatum and ASD. Oper Techn Thorac Cardiov Surg: Comp Atlas, 2015, 20(4): 384-401.
12.	Yaliniz H, Topcuoglu M S, Gocen U, et al. Comparison between minimal right vertical infra-axillary thoracotomy and standard median sternotomy for repair of atrial septal defects. Asian J Surg, 2015, 38(4): 199-204.
13.	Hu CX, Tan J, Chen S, et al. Comparison of clinical outcomes and postoperative recovery between two open heart surgeries: minimally invasive right subaxillary vertical thoracomy and traditional median sternotomy. Asian Pac J Trop Med, 2014, 7(8): 625-629.
14.	Yang X, Wang D, Wu Q. Repair of partial atrioventricular septal defect through a minimal right vertical infra-axillary thoracotomy. J Card Surg, 2003, 18(3): 262-264.
15.	An G, Zhang H, Zheng S, et al. Minimally invasive surgical closure for doubly committed subarterial ventricular septal defects through a right subaxillary thoracotomy. Interact Cardiovasc Thorac Surg, 2016, 23(6): 924-928.
16.	Yan L, Zhou ZC, Li HP, et al. Right vertical infra-axillary mini-incision for repair of simple congenital heart defects: a matched-pair analysis. Eur J Cardiothorac Surg, 2013, 43(1): 136-141.
17.	Nguyen K, Chin C, Lee D S, et al. The axillary incision: a cosmetic approach in congenital cardiac surgery. J Thorac Cardiovasc Surg, 2007, 134(5): 1358-1360.
18.	Wang Q, Li Q, Zhang J, et al. Ventricular septal defects closure using a minimal right vertical infraaxillary thoracotomy: seven-year experience in 274 patients. Ann Thorac Surg, 2010, 89(2): 552-555.

1. Hoffman JI. Incidence of congenital heart disease:Ⅰ. Postnatal incidence. Pediatr Cardiol, 1995, 16(3): 103-113.
2. Sondheimer HM, Rahimi-Alangi K. Current management of ventricular septal defect. Cardiol Young, 2006, 16(Suppl 3): 131-135.
3. Kogon B, Butler H, Kirshbom P, et al. Closure of symptomatic ventricular septal defects: how early is too early? Pediatr Cardiol, 2008, 29(1): 36-39.
4. Lillehei CW, Cohen M, Warden HE, et al. The direct-vision intracardiac correction of congenital anomalies by controlled cross circulation; results in thirty-two patients with ventricularseptal defects, tetralogy of Fallot, and atrioventricularis communis defects. Surgery, 1955, 38(1): 11-29.
5. Braile DM, Evora P. The "rebirth" of the right anterolateral thoracotomy approach in cardiac surgery. Braz J Cardiovasc Surg, 2018, 33(2): Ⅰ-Ⅱ.
6. Hong ZN, Chen Q, Lin ZW, et al. Surgical repair via submammary thoracotomy, right axillary thoracotomy and median sternotomy for ventricular septal defects. J Cardiothorac Surg, 2018, 13(1): 47.
7. Schreiber C, Bleiziffer S, Lange R, et al. Midaxillary lateral thoracotomy for closure of atrial septal defects in pre-pubescent female children: reappraisal of an "old technique". Cardiol Young, 2003, 13(6): 565-567.
8. Bleiziffer S, Schreiber C, Burgkart R, et al. The influence of right anterolateral thoracotomy in prepubescent female patients on late breast development and on the incidence of scoliosis. Thorac Cardiovasc Surg, 2004, 127(5): 1474-1480.
9. Pretre R, Kadner A, Dave H, et al. Right axillary incision: a cosmetically superior approach to repair a wide range of congenital cardiac defects. Thorac Cardiovasc Surg, 2005, 130(2): 277-281.
10. An G, Zhang H, Zheng S, et al. Mid-term outcomes of common congenital heart defects corrected through a right subaxillary thoracotomy. Heart Lung Circ, 2017, 26(4): 376-382.
11. Dodge-Khatami A, Salazar JD. Right axillary thoracotomy for transatrial repair of congenital heart defects: VSD, partial AV canal with mitral cleft, PAPVR/warden, cor triatriatum and ASD. Oper Techn Thorac Cardiov Surg: Comp Atlas, 2015, 20(4): 384-401.
12. Yaliniz H, Topcuoglu M S, Gocen U, et al. Comparison between minimal right vertical infra-axillary thoracotomy and standard median sternotomy for repair of atrial septal defects. Asian J Surg, 2015, 38(4): 199-204.
13. Hu CX, Tan J, Chen S, et al. Comparison of clinical outcomes and postoperative recovery between two open heart surgeries: minimally invasive right subaxillary vertical thoracomy and traditional median sternotomy. Asian Pac J Trop Med, 2014, 7(8): 625-629.
14. Yang X, Wang D, Wu Q. Repair of partial atrioventricular septal defect through a minimal right vertical infra-axillary thoracotomy. J Card Surg, 2003, 18(3): 262-264.
15. An G, Zhang H, Zheng S, et al. Minimally invasive surgical closure for doubly committed subarterial ventricular septal defects through a right subaxillary thoracotomy. Interact Cardiovasc Thorac Surg, 2016, 23(6): 924-928.
16. Yan L, Zhou ZC, Li HP, et al. Right vertical infra-axillary mini-incision for repair of simple congenital heart defects: a matched-pair analysis. Eur J Cardiothorac Surg, 2013, 43(1): 136-141.
17. Nguyen K, Chin C, Lee D S, et al. The axillary incision: a cosmetic approach in congenital cardiac surgery. J Thorac Cardiovasc Surg, 2007, 134(5): 1358-1360.
18. Wang Q, Li Q, Zhang J, et al. Ventricular septal defects closure using a minimal right vertical infraaxillary thoracotomy: seven-year experience in 274 patients. Ann Thorac Surg, 2010, 89(2): 552-555.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Effect of right vertical infra-axillary thoracotomy on the repair of ventricular septal defect in children

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