Minimally invasive surgical repair through right vertical infra-axillary thoracotomy for simple congenital heart defects

Nguyen Ly Thinh Truong, Tran Quang Vinh, Nguyen Tuan Mai,

Hoang Thanh Son, Mai Dinh Duyen, Doan Vuong Anh, Nguyen Trung Nam

Abstract

Objective: To evaluate the safety and efficacy of surgical repair for patients who are diagnosed with simple congenital heart defects (CHD) using minimally invasive of the right vertical infra-axillary mini-thoracotomy (RVIAT) approach.

Methods: We retrospective reviewed a consecutive of patients who underwent minimally invasive RVIAT repair for CHD between August 2019 to August 2022. There were 382 patients were included in this study with 8 primary procedures.

Results: Median age was 16.2 months [Interquartile range (IQR): 7.2-41.9 months] and median weight was 8.8 kg (IQR: 6.5-14 kg). Preoperative diagnosis was: ventricular septal defect (275/382; 72%), atrial septal defect (71/382; 18.6%), partial anomalous of pulmonary venous return (16/382; 4.2%), partial atrioventricular septal defect (16/382; 4.2%), cortriatriatum (2/382; 0.5%), complete atrioventricular septal defect (1/382; 0.3%), myxoma (1/382; 0.3%). Interestingly, there were 5 patients who failed from device catheterization closure of atrial septal defect. The mean aortic cross-clamp time, bypass time and operation time were 45.4 ± 19.3 minutes, 65.6 ± 23.1 minutes, and 154,5 ± 29.7 minutes, respectively. There were no in-hospital mortality and no conversions to median sternotomy.  Two patients (0.5%) required early reoperation: 1 has postoperative bleeding, and 1 has permanent pacemaker implantation. One patient required ECMO support (4 days) due to pulmonary edema after closure of atrial septal defect. Other complications included:  trivial residual shunt (23/382; 6%), pleural effusion (3/382; 0.8%), pneumothorax (0.8%), and wound infection (4/382; 1%). Median follow-up time was 11.3 months (IQR; 5.7-21.7 months). There was no late mortality. Late reoperation was performed on 1 patient with progress aortic valve regurgitation who required aortic valvuloplasty. No breast asymmetrical or chest deformity was found at the latest follow-up.

Conclusions: Minimally invasive using RVIAT approach can be safely performed in patients with simple CHD. The RVIAT may provide a good alternative approach for median sternotomy and cardiac intervention.