Right vertical infra-axillary thoracotomy in surgical repair for intra-cardiac congenital heart defects combined with patent ductus arteriosus_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHANG Shicheng ,  HUA Zhongdong

Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100037, P.R.China;

Corresponding?author：

HUA Zhongdong, Email: richardhua@yahoo.com

Keywords：

Right vertical infra-axillary approach; surgical repair; intra-cardiac congenital heart defects; patent ductus arteriosus; treatment

DOI：

10.7507/1007-4848.202001042

Video：

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Objective To investigate effectiveness and safety of right vertical infra-axillary thoracotomy (RVIAT) in surgical repair for intra-cardiac anomalies combined with patent ductus arteriosus (PDA).Methods We retrospectively analyzed the clinical data of 34 patients who underwent intra-cardiac correction of congenital heart defects and PDA ligation simultaneously via RVIAT in our hospital from August 2014 to August 2019. There were 25 males and 9 females with an age range of 0.5-6.1 years.Results The length of incision was 3.0 (3.0, 3.5) cm. The operation time lasted 110.0 (90.0, 121.0) min. The cardiopulmonary bypass time was 45.5 (38.8, 63.5) min and the aortic cross-clamp time was 22.5 (14.8, 34.8) min. The bleeding volume was 20.0 (13.8, 20.0) mL. ICU stay time was 17.0 (5.5, 22.3) h, post-operative mechanical ventilation time was 4.0 (2.0, 6.0) h, total in-hospital cost was 46 (39, 51) thousand yuan. There was no mortality or reoperation during perioperative and follow-up period. Within the median follow-up of 636.0 days, 1 patient had minimal residual ventricular septal defect shunt while no new-onset scoliosis, funnel chest or pectus carinatum was detected. No bilateral mammary developmental asymmetry was observed in the female patients during the follow-up period. All the patients’ parents or guardians were satisfied with the right vertical infra-axillary aesthetic skin incision.Conclusion The minimally invasive repair for intra-cardiac heart defects combined with PDA via RVIAT is a safe and effective method with minimal invasiveness and excellent cosmesis.

Citation： ZHANG Shicheng, HUA Zhongdong. Right vertical infra-axillary thoracotomy in surgical repair for intra-cardiac congenital heart defects combined with patent ductus arteriosus. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(5): 515-520. doi: 10.7507/1007-4848.202001042 Copy

1.	高開柱, 李小波, 李慶國, 等. 四種方法治療繼發孔房間隔缺損的比較. 心肺血管病雜志, 2019, 38(4): 399-402.
2.	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.
3.	Arkhipov AN, Omelchenko AY, Zubritskiy AV, et al. Thoracoscopic clipping of patent ductus arteriosus: position of surgery in the era of transcatheter procedures. Khirurgiia (Mosk), 2019, (2): 5-12.
4.	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.
5.	Rao RK, Varadaraju R, Basappa G, et al. Repair of sinus venosus defects with partial anomalous pulmonary venous connection in children by modified right vertical infra axillary thoracotomy. Innovations, 2019, 14(6): 553-557.
6.	Ito T, Atsuo M, Satoshi H, et al. Right infra-axillary mini-thoracotomy for aortic valve replacement. Masters Cardiothorac Surg, 2015, 1(4): 78-80.
7.	Xu C, Pan J, Zhou Q, et al. Right vertical infra-axillary thoracotomy for double valve replacement. J Card Surg, 2015, 30(5): 427-430.
8.	林明, 朱洪玉, 彭曉鵬, 等. 右腋下小切口直視心內手術 135 例手術體會. 中國實用醫藥, 2016, 11(16): 56-57.
9.	宋志斌, 衛向陽, 孫英民. 微創切口在 10 kg 以下嬰幼兒先天性心臟病中的應用研究. 中國心血管病研究, 2015, 13(8): 747-750.
10.	Jaroszewski DE, Gustin PJ, Haecker FM, et al. Pectus excavatum repair after sternotomy: the Chest Wall International Group experience with substernal Nuss bars. Eur J Cardiothorac Surg, 2017, 52(4): 710-717.
11.	Tan EM, Lyle M, Cawcutt K, et al. Poststernotomy osteomyelitis presenting with severe sepsis and rhabdomyolysis. Case Rep Med, 2016, 2016: 4507012.
12.	Wang Q, Ye JX, Ge M, et al. Early- and long-term outcomes of cardiovascular surgery via minimal right vertical infra-axillary thoracotomy: a 15-year study of 1,126 patients. Sci Rep, 2018, 8(1): 4376.
13.	Minol JP, Akhyari P, Boeken U, et al. Single-centre experience of mitral valve surgery via right lateral mini-thoracotomy in octogenarians. Interact Cardiovasc Thorac Surg, 2016, 22(3): 287-290.
14.	Garcia AV, Lukish J. Minimally invasive patent ductus arteriosus ligation. Clin Perinatol, 2017, 44(4): 763-771.
15.	Marconi E, Bettiol A, Ambrosio G, et al. Efficacy and safety of pharmacological treatments for patent ductus arteriosus closure: A systematic review and network meta-analysis of clinical trials and observational studies. Pharmacol Res, 2019, 148: 104418.
16.	Baruteau AE, Hasco?t S, Baruteau J, et al. Transcatheter closure of patent ductus arteriosus: past, present and future. Arch Cardiovasc Dis, 2014, 107(2): 122-132.
17.	Gu Q, Ma L, Gu H, et al. A hybrid approach for patent ductus arteriosus closure using the amplatzer duct occluder. J Card Surg, 2018, 33(10): 684-687.
18.	Wang K, Pan X, Tang Q, et al. Catheterization therapy vs surgical closure in pediatric patients with patent ductus arteriosus: A meta-analysis. Clin Cardiol, 2014, 37(3): 188-194.
19.	Lam JY, Lopushinsky SR, Ma IWY, et al. Treatment options for pediatric patent ductus arteriosus: Systematic review and meta-analysis. Chest, 2015, 148(3): 784-793.
20.	梁維杰, 范太兵, 宋書波, 等. 經左腋下小切口治療小兒室間隔缺損合并動脈導管未閉8例臨床觀察. 中華實用診斷與治療雜志, 2017, 31(11): 1084-1086.

1. 高開柱, 李小波, 李慶國, 等. 四種方法治療繼發孔房間隔缺損的比較. 心肺血管病雜志, 2019, 38(4): 399-402.
2. 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.
3. Arkhipov AN, Omelchenko AY, Zubritskiy AV, et al. Thoracoscopic clipping of patent ductus arteriosus: position of surgery in the era of transcatheter procedures. Khirurgiia (Mosk), 2019, (2): 5-12.
4. 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.
5. Rao RK, Varadaraju R, Basappa G, et al. Repair of sinus venosus defects with partial anomalous pulmonary venous connection in children by modified right vertical infra axillary thoracotomy. Innovations, 2019, 14(6): 553-557.
6. Ito T, Atsuo M, Satoshi H, et al. Right infra-axillary mini-thoracotomy for aortic valve replacement. Masters Cardiothorac Surg, 2015, 1(4): 78-80.
7. Xu C, Pan J, Zhou Q, et al. Right vertical infra-axillary thoracotomy for double valve replacement. J Card Surg, 2015, 30(5): 427-430.
8. 林明, 朱洪玉, 彭曉鵬, 等. 右腋下小切口直視心內手術 135 例手術體會. 中國實用醫藥, 2016, 11(16): 56-57.
9. 宋志斌, 衛向陽, 孫英民. 微創切口在 10 kg 以下嬰幼兒先天性心臟病中的應用研究. 中國心血管病研究, 2015, 13(8): 747-750.
10. Jaroszewski DE, Gustin PJ, Haecker FM, et al. Pectus excavatum repair after sternotomy: the Chest Wall International Group experience with substernal Nuss bars. Eur J Cardiothorac Surg, 2017, 52(4): 710-717.
11. Tan EM, Lyle M, Cawcutt K, et al. Poststernotomy osteomyelitis presenting with severe sepsis and rhabdomyolysis. Case Rep Med, 2016, 2016: 4507012.
12. Wang Q, Ye JX, Ge M, et al. Early- and long-term outcomes of cardiovascular surgery via minimal right vertical infra-axillary thoracotomy: a 15-year study of 1,126 patients. Sci Rep, 2018, 8(1): 4376.
13. Minol JP, Akhyari P, Boeken U, et al. Single-centre experience of mitral valve surgery via right lateral mini-thoracotomy in octogenarians. Interact Cardiovasc Thorac Surg, 2016, 22(3): 287-290.
14. Garcia AV, Lukish J. Minimally invasive patent ductus arteriosus ligation. Clin Perinatol, 2017, 44(4): 763-771.
15. Marconi E, Bettiol A, Ambrosio G, et al. Efficacy and safety of pharmacological treatments for patent ductus arteriosus closure: A systematic review and network meta-analysis of clinical trials and observational studies. Pharmacol Res, 2019, 148: 104418.
16. Baruteau AE, Hasco?t S, Baruteau J, et al. Transcatheter closure of patent ductus arteriosus: past, present and future. Arch Cardiovasc Dis, 2014, 107(2): 122-132.
17. Gu Q, Ma L, Gu H, et al. A hybrid approach for patent ductus arteriosus closure using the amplatzer duct occluder. J Card Surg, 2018, 33(10): 684-687.
18. Wang K, Pan X, Tang Q, et al. Catheterization therapy vs surgical closure in pediatric patients with patent ductus arteriosus: A meta-analysis. Clin Cardiol, 2014, 37(3): 188-194.
19. Lam JY, Lopushinsky SR, Ma IWY, et al. Treatment options for pediatric patent ductus arteriosus: Systematic review and meta-analysis. Chest, 2015, 148(3): 784-793.
20. 梁維杰, 范太兵, 宋書波, 等. 經左腋下小切口治療小兒室間隔缺損合并動脈導管未閉8例臨床觀察. 中華實用診斷與治療雜志, 2017, 31(11): 1084-1086.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Right vertical infra-axillary thoracotomy in surgical repair for intra-cardiac congenital heart defects combined with patent ductus arteriosus

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