Ali Dodge-Khatami
University of Mississippi Medical Center, USA
Title: Right axillary thoracotomy for transatrial repair of congenital heart defects: VSD, partial AV canal with mitral cleft, PAPVR/Warden, Cor Triatriatum and ASD
Biography
Biography: Ali Dodge-Khatami
Abstract
Objectives: When wanting to avoid a median sternotomy, the muscle-sparing right axillary thoracotomy has successfully been used for the transatrial repair of more simple congenital heart defects. With additional surgical experience using this approach, the spectrum of defects amenable to a quality repair has expanded.
Methods: Between 2008-2016, 48 patients (26 ASD, 10 ventricular septal defects (VSD) (including 3 with double –chambered right ventricle (DCRV), 8 Warden operations for partial anomalous pulmonary venous return (PAPVR), 3 partial atrio-ventricular canals with mitral valve cleft, and 1 cor triatriatum) underwent surgical repair through the right chest, using either induced ventricular fibrillation or aortic cross-clamping with cardioplegic arrest. The attached surgical video shows closure of a ventricular septal defect in a 10 month old infant girl.
Results: Age ranged between 4 months-18 years, and weight from 5.5-82kg. There was no mortality, no residual defects or peri-operative complications.
Conclusions: The muscle-sparing right axillary approach is a safe and reproducible technique to repair congenital heart defects typically accessible through the right atrium. In our experience, compared to other thoracic incisions, the approach is far away from breast tissue which is easily spared with minimal potential for future asymmetrical breast growth, no muscles are sacrificed with rapid functional recovery of the right arm and shoulder, and the cosmetic results highly appreciated by parents and patients alike. With gained expertise and surgeon comfort, the same high standards as through a median sternotomy are maintained without compromising repair quality.