Abstract

Objective: The right vertical infra - axillary incision has been applied for open - heart surgery with a higher cosmetic result and comparable outcomes, and was considered as an alternative to standard median sternotomy. This study aimed to evaluate the efficacy and safety of the right vertical infra-axillary incision for the correction of simple congenital heart defects in children at National Hospital of Pediatric.
Methods: From August 2019 to December 2020, a consecutive of patients who underwent open heart surgery via the right vertical infra-axillary incision in our center was collected to this study.
Results: There were 99 childrens who underwent open heart surgery using the right vertical infra - axillary incision for simple congenital heart defects correction during the study period. The meanage 52,96 ± 44,97 months (5 - 181) and the mean weight
15,31 ± 8,65 kg (6 - 54). There were 43 patients undergoing ASD closure, 40 patients underwent VSD closure, 8 patients have partial atrioventricular septal defect, 8 patients have partial anomalous pulmonary venous connection with 2 patients underwent
modified Warden procedure. The mean aortic cross clamp time and cardiopulmonary bypass time were 40,08 ± 22,70 min (10 - 118) and 60,65 ± 27,18 min (25 - 172), respectively. There were no hospital deaths and late deaths. There was no patient required conversion to sternotomy approach. 1 patient needed reoperation to enlarge PFO with ECMO support due to heart failure, and successfully withdrawn ECMO after 3 days. 1 patient with complete AV block requires permanent pacemaker placement. Follow - up echocardiography showed no residual ASD or VSD, no moderate - severe tricuspid and mitral regurgitation. All patients are in excellent condition with a mean follow - up of 6,91 ± 3,85 (2 - 18) months. The incision healed well, and the thorax with the breast showed no deformity at the latest follow-up.
Conclusions: The surgical outcomes of open heart surgery using the right vertical infra - axillary incision is safe and high effective for corrective of simple congenital heart defects in children, with lower trauma and higher cosmetic results. This approach provides a good alternative to the standard median sternotomy with individual selected patients.