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Said SM, Greathouse KC, McCarthy CM, Brown N, Kumar S, Salem MI, Kloesel B, Sainathan S. Safety and Efficacy of Right Axillary Thoracotomy for Repair of Congenital Heart Defects in Children. World J Pediatr Congenit Heart Surg 2023; 14:47-54. [PMID: 36847761 DOI: 10.1177/21501351221127283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
BACKGROUND Minimally invasive repair of congenital heart defects in children has not gained wide popularity yet compared to minimally invasive approaches in adults. We sought to review our experience with this approach in children. METHODS This study included a total of 37 children (24 girls, 64.9%) with a mean age of 6.5 ± 5.1 years, who underwent vertical axillary right minithoracotomy for repair of a variety of congenital heart defects between May 2020 and June 2022. RESULTS The mean weight of these children was 25.66 ± 18.3 kg. Trisomy 21 syndrome was present in 3 patients (8.1%). The most common congenital heart defects that were repaired via this approach were atrial septal defects (secundum in 11 patients, 29.7%; primum in 5, 13.5%; and unroofed coronary sinus in 1, 2.7%). Twelve patients (32.4%) underwent repair of partial anomalous pulmonary venous connections with or without sinus venosus defects, while 4 patients (10.8%) underwent closure of membranous ventricular septal defects. Mitral valve repair, resection of cor triatriatum dexter, epicardial pacemaker placement, and myxoma resection occurred in 1 patient (2.7%) each. No early mortality or reoperations. All patients were extubated in the operating room, and the mean length of hospital stay was 3.3 ± 2.04 days. Follow-up was complete (mean 7 ± 5 months). No late mortality or reoperations. One patient required epicardial pacemaker placement due to sinus node dysfunction 5 months after surgery. CONCLUSIONS Vertical axillary right thoracotomy is a cosmetically superior approach that is safe and effective for repair of a variety of congenital heart defects in children.
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Affiliation(s)
- Sameh M Said
- Division of Pediatric Cardiovascular Surgery, Department of Surgery, Maria Fareri Children's Hospital, 8138Westchester Medical Center, New York Medical College, Valhalla, NY, USA.,Faculty of Medicine, 54562Alexandria University, Alexandria, Egypt
| | - Kristin C Greathouse
- M Health Fairview Health System, Masonic Children's Hospital, Minneapolis, MN, USA
| | - Christina M McCarthy
- M Health Fairview Health System, Masonic Children's Hospital, Minneapolis, MN, USA
| | - Nicholas Brown
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Masonic Children's Hospital, 5635University of Minnesota, Minneapolis, MN, USA
| | - Sacha Kumar
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Masonic Children's Hospital, 5635University of Minnesota, Minneapolis, MN, USA
| | - Mahmoud I Salem
- Department of Cardiothoracic Surgery, 289164Port Said University, Port Said, Egypt
| | - Benjamin Kloesel
- Department of Anesthesiology, 5635University of Minnesota, Minneapolis, MN, USA
| | - Sandeep Sainathan
- Department of Cardiothoracic Surgery, 12235University of Miami, Miller School of Medicine, Miami, FL, USA
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Yang X, Hu Y, Dong J, Huang P, Luo J, Yang G, Deng X. Rightvertical axillary incision for atrial septal defect: a propensity score matched study. J Cardiothorac Surg 2022; 17:256. [PMID: 36199116 PMCID: PMC9535985 DOI: 10.1186/s13019-022-01999-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 09/24/2022] [Indexed: 11/10/2022] Open
Abstract
Background Atrial septal defect is one of the most common types of congenital heart disease. This study aims to explore the surgical and cosmetic effects of open-heart surgery with right vertical axillary incision for simple congenital heart disease in infants. Methods From June 2018 to October 2021, children who underwent direct surgery of atrial septal defect in our department were selected for a propensity score matched study. Those with direct surgery through the right vertical axillary incision were included in the right vertical axillary incision group. According to age and weight, propensity score matching method was employed to match children from the right vertical axillary incision group with those undergoing direct surgery through median sternotomy (median sternotomy group) at a 1:2 ratio. Surgery outcomes between two groups were compared to evaluate the effectiveness and safety of right vertical axillary incision group. Results The median incision length (median, [interquartile range]) in right vertical axillary incision group (4.8 cm, [4.0–5.0]) was shorter than that in median sternotomy group (p < 0.001). The median drainage volume of drainage tube of the right vertical axillary incision group (117.5 ml, [92.8,152.8]) was smaller than that of median sternotomy group (p = 0.021). While no residual bubbles cases in the left and right ventricles and outflow tract were present in the right vertical axillary incision group, 44% of residual air bubble rate in right ventricular outflow tract was detected in median sternotomy group (p = 0.001). Additional sedation and analgesia (p = 0.003), wound infection or poor healing (p = 0.047), thoracic deformity healing (p = 0.029) and appearance satisfaction questionnaire (p = 0.018) in the right vertical axillary incision group were better than those in the median sternotomy group. Conclusion Right axillary vertical incision can effectively reduce surgical trauma, accelerate postoperative rehabilitation. This surgical approach also provides better cosmetic effect, which is easily accepted by children’s families and worthy of further clinical application.
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Affiliation(s)
- Xiaohui Yang
- Heart Center, Hunan Children's Hospital, No. 86 Ziyuan Road, 410007, Changsha, China
| | - Yuan Hu
- Department of Echocardiography and Ultrasound, Hunan Children's Hospital, 410007, Changsha, China
| | - Jie Dong
- Pediatrics Research Institute of Hunan Province, Hunan Children's Hospital, Changsha, China
| | - Peng Huang
- Heart Center, Hunan Children's Hospital, No. 86 Ziyuan Road, 410007, Changsha, China
| | - Jinwen Luo
- Heart Center, Hunan Children's Hospital, No. 86 Ziyuan Road, 410007, Changsha, China
| | - Guangxian Yang
- Heart Center, Hunan Children's Hospital, No. 86 Ziyuan Road, 410007, Changsha, China
| | - Xicheng Deng
- Heart Center, Hunan Children's Hospital, No. 86 Ziyuan Road, 410007, Changsha, China.
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Konstantinov IE, Kotani Y, Buratto E, Schulz A, Ivanov Y. Minimally invasive approaches to atrial septal defect closure. JTCVS Tech 2022; 14:184-190. [PMID: 35967196 PMCID: PMC9366208 DOI: 10.1016/j.xjtc.2022.02.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 02/17/2022] [Indexed: 10/29/2022] Open
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Doubly committed subarterial ventricular septal defect closure through tricuspid approach: a clinical analysis. Cardiol Young 2021; 31:799-803. [PMID: 33504385 DOI: 10.1017/s1047951120004643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The research was to introduce the experience of doubly committed subarterial ventricular septal defect (DCVSD) repaired through tricuspid approach. METHODS From January, 2015 to September, 2019, 86 consecutive DCVSD paediatrics underwent repair via right subaxillary vertical incision (RAVI) through tricuspid approach. Perioperative and follow-up data were collected. RESULTS The age and weight at operation were 28.1 ± 18.5 (range: 7-101) months and 12.2 ± 4.2 (6-26.5) kg. There were two patients combined with discrete subaortic membrane, two patients with patent ductus arteriosus, one patient with atrial septal defect, and two patients with abnormal muscle bundle in right ventricular outflow tract. The mean size of ventricular septal defect was 7.0 ± 2.4 (3-13) mm. The defect was repaired with a piece of Dacron patch in 68 patients or directly with 1-2 pledgetted polypropylene sutures in 18 patients. The cardiopulmonary bypass time and aortic cross-clamp time were 46.2 ± 13.3 (23-101) minutes and 29.2 ± 11.5 (12-84) minutes. After 3.1 ± 2.4 (0-14) hours' ventilator assist and 23.2 ± 32.1 (0-264) hours' ICU stay, all patients were discharged safely. At the latest follow-up (27.9 ± 14.6 months), echocardiography showed trivial residual shunt in two patients. There was no malignant arrhythmia occurred and there was no chest deformity or asymmetrical development of the breast was found. CONCLUSIONS DCVSD repaired via right subaxillary vertical incision through tricuspid approach was safe and feasible, providing a feasible alternative to median sternotomy, and it can be performed with favourable cosmetic results.
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An K, Li S, Yan J, Wang X, Hua Z. Minimal Right Vertical Infra-axillary Incision for Repair of Congenital Heart Defects. Ann Thorac Surg 2021; 113:896-902. [PMID: 33592183 DOI: 10.1016/j.athoracsur.2021.01.052] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 12/30/2020] [Accepted: 01/22/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND This study evaluated the surgical results of a diverse array of congenital heart defects through minimal right vertical infra-axillary incision (RVIAI). METHODS We performed a retrospective review of consecutive patients using minimal RVIAI for congenital heart defects between 2015 and 2019. The study included 1672 patients and minimal RVIAI was used for 13 primary procedures. The incision was 2.0 to 4.0 cm in all patients. RESULTS Median age was 2.3 years (range, 0.2-6.0 years) and median weight was 12.5 kg (range, 5.0-34.0 kg). There were no in-hospital deaths or conversions to median sternotomy. Five patients underwent early reoperations (0.3%; 3 had postoperative bleeding, 1 had coarctation of ascending aorta owing to cannulation, and 1 had a major residual shunt). Other postoperative complications included a trivial residual shunt in 16 patients (1.0%), pleural effusion in 3 (0.2%), and wound infection in 4 (0.2%). Median follow-up was 3.2 years (range, 0.2-4.9 years). There were no late deaths or late reoperations. During follow-up, no surgery-related thoracic deformity or breast asymmetry was noted. One patient had mild scoliosis. We randomly chose 100 patients to complete a questionnaire regarding patient satisfaction with minimal RVIAI. Results showed that all patients and their parents were satisfied with the cosmetic results. CONCLUSIONS Minimal RVIAI can be safely performed for a wide range of congenital heart defects with excellent cosmetic results. It may serve as a good alternative to median sternotomy, especially for young female patients.
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Affiliation(s)
- Kang An
- Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People's Republic of China
| | - Shoujun Li
- Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People's Republic of China
| | - Jun Yan
- Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People's Republic of China
| | - Xu Wang
- Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People's Republic of China
| | - Zhongdong Hua
- Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People's Republic of China.
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Li C, Gong X, Huang J, Zhu L, Dong W, Zhang M, Liu Y, Xu Z. Effects of repairing ventricular septal defects with right vertical infra-axillary mini-incision on lung function and postoperative analgosedation. Exp Ther Med 2021; 21:302. [PMID: 33717245 PMCID: PMC7885067 DOI: 10.3892/etm.2021.9733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 01/06/2021] [Indexed: 11/06/2022] Open
Abstract
The present study aimed to assess the effects of repairing ventricular septal defects (VSDs) with right vertical infra-axillary mini-incision (RVAI). A total of 116 patients with VSDs were prospectively enrolled and underwent cardiac surgery between June 2017 and December 2018 at the cardiac intensive care unit of Shanghai Children's Medical Center (Shanghai, China). Of these, 58 patients underwent the RVAI procedure and 58 patients matched 1:1 underwent the standard median sternotomy incision (MSI) procedure and were designated as the control group. The demographic data and clinical outcomes intra- and postoperatively were compared. A bedside lung ultrasound was performed to evaluate the degree of lung injury and the number of B-lines was quantified and compared between the two groups. The sedation and analgesia levels were also assessed after the operation. No significant difference was identified between the two groups regarding the overall cardiopulmonary bypass or aortic cross-clamp time. All patients were extubated within 8 h. The RVAI group had shorter incision lengths (median, 4.6 cm) and less drainage (median, 15 ml) than the MSI group. Furthermore, compared to the MSI group, the RVAI group had a significantly higher number of B-lines in the right lung regions immediately after surgery and at 12 h postsurgery (24.1 and 5.2%, respectively) but eventually exhibited no differences at 24 and 36 h postsurgery; by contrast, there were no differences in the left lung regions. The bedside bispectral index score and the Face, Legs, Activity, Cry, Consolability scale score exhibited no significant differences after the operation. In conclusion, the RVAI procedure appears to be a safe alternative for repairing VSDs in addition to satisfactory cosmetic results and the incision does not interfere with postoperative analgosedation.
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Affiliation(s)
- Chunxiang Li
- Department of Cardiac Intensive Care Unit, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai 200127, P.R. China
| | - Xiaolei Gong
- Department of Cardiac Intensive Care Unit, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai 200127, P.R. China
| | - Jihong Huang
- Department of Cardiac Intensive Care Unit, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai 200127, P.R. China
| | - Limin Zhu
- Department of Cardiac Intensive Care Unit, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai 200127, P.R. China
| | - Wei Dong
- Department of Cardiac Intensive Care Unit, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai 200127, P.R. China
| | - Mingjie Zhang
- Department of Cardiac Intensive Care Unit, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai 200127, P.R. China
| | - Yujie Liu
- Department of Cardiac Intensive Care Unit, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai 200127, P.R. China
| | - Zhuoming Xu
- Department of Cardiac Intensive Care Unit, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai 200127, P.R. China
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Yang M, Su J, Liu A, Fan X, Li G, Li B, Liu Y. Correction of simple congenital heart defects by right axillary thoracotomy in adults. J Card Surg 2019; 34:1172-1177. [PMID: 31475401 DOI: 10.1111/jocs.14172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Right axillary thoracotomy has been performed for open-heart procedures as a more aesthetic alternative to standard median sternotomy. This study aimed to evaluate the efficacy and safety of right axillary thoracotomy for the correction of simple congenital heart defects in adults. METHODS Between January 2014 and December 2017, the clinical data of 180 adults who underwent right axillary thoracotomy for simple congenital heart defects were compared with the data of a paired group of 192 adults who underwent median sternotomy. RESULTS Compared with the median sternotomy group, the right thoracotomy group showed shorter operative time, postoperative mechanical ventilation time, and postoperative hospitalization duration, as well as less drainage and transfusion volumes (P < .05). Aortic cross-clamping time, cardiopulmonary bypass time, and length of intensive care unit stay were similar between groups. No mortality or significant residual defects were reported in either group during follow-up. In total, 172 patients (95.6%) in the right thoracotomy group and 134 patients (69.8%) in the median sternotomy group were satisfied with their cosmetic results (P < .01). CONCLUSIONS A right axillary thoracotomy is as safe and effective as a median sternotomy for the correction of simple congenital heart defects in adults. With lower trauma and better cosmetic results, this procedure provides a good alternative to the standard median sternotomy.
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Affiliation(s)
- Ming Yang
- Pediatric Cardiac Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Junwu Su
- Pediatric Cardiac Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Aijun Liu
- Pediatric Cardiac Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiangming Fan
- Pediatric Cardiac Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Gang Li
- Pediatric Cardiac Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Bin Li
- Pediatric Cardiac Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yinglong Liu
- Pediatric Cardiac Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Liu R, Rui L, Zhang B, Lin Y, Li S, Hua Z. Through Tricuspid Closure for Doubly Committed Subarterial Ventricular Septal Defect with Right Vertical Subaxillary Mini-incision: A Matched-Pair Analysis. Pediatr Cardiol 2019; 40:1247-1252. [PMID: 31338560 DOI: 10.1007/s00246-019-02144-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 06/19/2019] [Indexed: 11/28/2022]
Abstract
To evaluate the feasibility and efficacy of the right subaxillary vertical mini-incision (RAVI) used for the closure of doubly committed subarterial ventricular septal defect (SAVSD) through tricuspid approach only. From June 2015 to September 2016, 32 SAVSD patients (mean age 2.4 ± 1.9 years, range 0.7-8 years) underwent surgical repair with either RAVI (incision length 3-4 cm) through tricuspid (group A, n = 16) or conventional median sternotomy incision through the main pulmonary artery approach (group B, n = 16). A retrospective 1:1 matched-pair analysis was performed with the group B matched for defect size, body weight, gender, patching, and operation year. The demographic characteristics in both groups were similar. No patient died and only 1 patient in group B needed reoperation for sternal infection. The mean cardiopulmonary bypass (CPB) time and aortic cross-clamp time were 48.6 ± 12.6 min, 29.3 ± 8.5 min in the group A and 57.8 ± 14.1 min (p = 0.03), 34.3 ± 12.1 min ( p = 0.18) in the group B. There was no significant difference between the two groups in the ICU stay (17.8 ± 8.9 h in group A, 18.7 ± 9.5 h in group B, p = 0.79), mechanical ventilation support time (2.7 ± 1.7 h in group A, 3.6 ± 1.5 h in group B, p = 0.11), postoperative hospital stay (6.3 ± 1.5 days in group A, 7.4 ± 1.7 days in group B, p = 0.06), and chest tube drainage (6.4 ± 4.3 ml/kg in group A, 8.5 ± 3.8 ml/kg in group B, p = 0.16). No significant residual defects were found in both groups. The post-operation pressure gradient across the right ventricular outflow tract (RVOT) was significantly different between the two groups with 4.6 ± 1.8 mmHg in group A and 10.0 ± 6.8 mmHg in group B (p = 0.004) even if no significant difference was found between both groups before operation. No arrhythmia was found after operation. All the patients or the parents (100%) in the group A were satisfied with the cosmetic results, while the number in B group was 7 (43.8%) in questionnaire. The RAVI through tricuspid approach to repair doubly committed subarterial ventricular septal defect is a safe and feasible procedure with better hemodynamic performance of RVOT and less CPB time because of keeping pulmonary artery intact comparing to conventional approach. More importantly, the RAVI through tricuspid approach can be performed with favorable cosmetic results.
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Affiliation(s)
- Rui Liu
- Division of Pediatric Cardiac Surgical Centre, Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China
| | - Lu Rui
- Division of Pediatric Cardiac Surgical Centre, Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China
| | - Benqing Zhang
- Division of Pediatric Cardiac Surgical Centre, Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China
| | - Ye Lin
- Division of Pediatric Cardiac Surgical Centre, Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China
| | - Shoujun Li
- Division of Pediatric Cardiac Surgical Centre, Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China
| | - Zhongdong Hua
- Division of Pediatric Cardiac Surgical Centre, Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China.
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Vida VL, Zanotto L, Zanotto L, Tessari C, Padalino MA, Zanella F, Pittarello D, Stellin G. Minimally invasive surgery for atrial septal defects: a 20-year experience at a single centre. Interact Cardiovasc Thorac Surg 2019; 28:961-967. [DOI: 10.1093/icvts/ivz017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 12/21/2018] [Accepted: 12/27/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Vladimiro L Vida
- Paediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Lorenza Zanotto
- Paediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Lucia Zanotto
- Department of Statistical Sciences, University of Padua, Padua, Italy
| | - Chiara Tessari
- Paediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Massimo A Padalino
- Paediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Fabio Zanella
- Cardiac Perfusion Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Azienda Ospedaliera of Padua, University of Padua, Padua, Italy
| | - Demetrio Pittarello
- Cardiac Anesthesia Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Giovanni Stellin
- Paediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
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Vertical Right Axillary Mini-Thoracotomy for Correction of Ventricular Septal Defects and Complete Atrioventricular Septal Defects. Ann Thorac Surg 2018; 106:1220-1227. [DOI: 10.1016/j.athoracsur.2018.05.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 04/28/2018] [Accepted: 05/03/2018] [Indexed: 11/23/2022]
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Lee T, Weiss AJ, Williams EE, Kiblawi F, Dong J, Nguyen KH. The Right Axillary Incision: A Potential New Standard of Care for Selected Congenital Heart Surgery. Semin Thorac Cardiovasc Surg 2018; 30:310-316. [DOI: 10.1053/j.semtcvs.2018.02.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2018] [Indexed: 11/11/2022]
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Kawashima T, Sato F. Anatomical visualization of neural course and distribution of anterior ascending aortic plexus. Heart Vessels 2017; 32:1262-1270. [PMID: 28516212 DOI: 10.1007/s00380-017-0993-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 05/12/2017] [Indexed: 11/30/2022]
Abstract
The aim of this study was to document the detailed anatomy of neural course and distribution on the anterior ascending aorta, to identify the high and low density areas of the anterior ascending aortic plexus for further understandings in cardiovascular surgery. The embalmed hearts of 42 elderly individuals were submacroscopically and microscopically examined, after excluding any that were macroscopically abnormal. With its origins in the anterior ascending aortic plexus, the right coronary plexus substantially innervated the right coronary artery, the right atrium and ventricle, and the sinus node. The intensive neural area extending from 10 mm lateral to the interatrial groove below the pericardial reflection as far as the right coronary artery opening contained almost all the right coronary plexus in 61.3% of patients, and more than 40.9% of the total nerve volume of the anterior ascending aortic plexus. Our findings suggest that the most superior and lateral area on the ascending aorta show the lowest neural density of right coronary component in the anterior ascending aortic plexus and the high density areas are invisible in right lateral field of view as seen in the right trans-axillary MICS approach.
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Affiliation(s)
- Tomokazu Kawashima
- Department of Anatomy, School of Medicine, Toho University, 5-21-16 Omori-Nish, Ota-ku, Tokyo, 143-8540, Japan.
| | - Fumi Sato
- Department of Anatomy, School of Medicine, Toho University, 5-21-16 Omori-Nish, Ota-ku, Tokyo, 143-8540, Japan
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Mid-term Outcomes of Common Congenital Heart Defects Corrected Through a Right Subaxillary Thoracotomy. Heart Lung Circ 2017; 26:376-382. [DOI: 10.1016/j.hlc.2015.05.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 05/06/2015] [Accepted: 05/07/2015] [Indexed: 11/17/2022]
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14
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An G, Zhang H, Zheng S, Wang W, Wu Q, Xing Q. Minimally invasive surgical closure for doubly committed subarterial ventricular septal defects through a right subaxillary thoracotomy. Interact Cardiovasc Thorac Surg 2016; 23:924-928. [DOI: 10.1093/icvts/ivw255] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 06/04/2016] [Accepted: 06/22/2016] [Indexed: 11/13/2022] Open
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Naimo PS, Konstantinov IE. Small Incisions for Small Children: Is Right Lateral Thoracotomy a Right Approach in Open Heart Surgery in Infants? Heart Lung Circ 2016; 25:104-6. [DOI: 10.1016/j.hlc.2015.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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16
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Zhang Q, Zhou ZC, Lin M, Wang HT, Zhao ZW, Ge JJ. Thoracoscope-assisted Right Vertical Infra-axillary Mini-incision for Cardiac Surgery. Heart Lung Circ 2015; 24:590-4. [DOI: 10.1016/j.hlc.2014.11.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 11/17/2014] [Accepted: 11/24/2014] [Indexed: 10/24/2022]
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The arrowhead ministernotomy with rigid sternal plate fixation: a minimally invasive approach for surgery of the ascending aorta and aortic root. Minim Invasive Surg 2014; 2014:681371. [PMID: 25485148 PMCID: PMC4251070 DOI: 10.1155/2014/681371] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 11/05/2014] [Indexed: 11/18/2022] Open
Abstract
Background. Ministernotomy incisions have been increasingly used in a variety of settings. We describe a novel approach to ministernotomy using arrowhead incision and rigid sternal fixation with a standard sternal plating system. Methods. A small, midline, vertical incision is made from the midportion of the manubrium to a point just above the 4th intercostal mark. The sternum is opened in the shape of an inverted T using two oblique horizontal incisions from the midline to the sternal edges. At the time of chest closure, the three bony segments are aligned and approximated, and titanium plates (Sternalock, Jacksonville, Florida) are used to fix the body of the sternum back together. Results. This case series includes 11 patients who underwent arrowhead ministernotomy with rigid sternal plate fixation for aortic surgery. The procedures performed were axillary cannulation (n = 2), aortic root replacement (n = 3), valve sparing root replacement (n = 3), and replacement of the ascending aorta (n = 11) and/or hemiarch (n = 2). Thirty-day mortality was 0%; there were no conversions, strokes, or sternal wound infections. Conclusions. Arrowhead ministernotomy with rigid sternal plate fixation is an adequate minimally invasive approach for surgery of the ascending aorta and aortic root.
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Arslan G, Ugur M, Alp İ, Temizkan V. Is the right vertical axillary incision an alternative technique to the submammarian incision for the repair of simple congenital heart defects in female patients? Eur J Cardiothorac Surg 2013; 44:584-5. [PMID: 23525152 DOI: 10.1093/ejcts/ezt159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Yan L, Zhou ZC, Li HP, Ge JJ. Reply to Arslan et al. Eur J Cardiothorac Surg 2013; 44:585-6. [PMID: 23520234 DOI: 10.1093/ejcts/ezt161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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