Use Of Right Subaxillary Minithoracotomy Vs Median Sternotomy For Treatment Of Congenital Heart Defects In Childnen

Objective: Surgical repair of congenital heart defects is both efficacious and safe using conventional median sternotomy and cardiopulmonary bypass, with the development of minimally invasive cardie surgical procedures in resent years, many minimal incisions have been used to perform operoations on patients with congenital heart defects. Among them, right subaxillary minithoracotomy is one of the most commonly used appoaches. But whether this small incision really has additional advantages over the conventional median sternotomy has not been- (2002) i:^JkifeJC _ Udefined. This study was designed to evaluate the clinical effects of right subaxillary minithoracotomy in the repair of congenital heart defects in children with conventional median sternotomy.Methods: We selected 40 patients with artrial septal defects (ASD)or ventricular septal defects (VSD). They were randomized into two group: right subaxillary minithoracotomy groupand conventional median sternotomy group. There were no significant differences with respect to age, sex,type of septal defects, weight, hemoglobin, heart ?chest ratio between the two group. The diagnoses were made in all patients using Doppler echocardiography.In the median sternotomy group, the procedure were performed in the conventional manner. In the right subaxillary minithoracotomy group, the skin incision was 6 to 10cm. In both group, cardiopulmonary and micro-dose warm blood cardioplegia perfusion was used.Morbidity ,duration of procedure (skin to skin), aotic cross-clamp time, bypass time, postoperative chest tube drainge for 24 hours,time of ventilation, length of intensive care unit and length of hospital stay were recorded. The condition of incisional painv (2002)after discharge was also evaluated. Echocardiography was used to assess the effect of procedures 1 month after operation in all patients. Follow-up was at least 3 months postoperating .Result: There was no operative mortality.The duraiton of operation procedure in the right subaxillary minithoracotomy group was longer than that in the median sternotomy group(p<0.05),but there were no significant differences between the two groups with respect to the bypass time, aortic cross-clamping time, ventilation duration, and intensive care unit stay.The drainge for 24 hours in the right subaxillary minithoracotomy was less than in the median sternotomy group (p<0.01), and the mumber of patient requiring blood transfusion was less than in the median thoracotomy group . There was a shorter hospital stay in the right subaxillary minithoracotomy group than in the median sternotomy group(/'<0.05). Although the number of patients complaining about incisional pain 1 month after operation in the subaxillary minithoractomy group was more than the median thoracotomy group ,this did not reach significant difference compared with the median sternotomy group(/;>>0.05).(2002)Conclusion: Compared with median sternotomy, three advantages were found in the right subaxillary thoracotomy group:First, less postoperative chest tube drainge occurred. Second, there was a shorter stay time in the hospital. Third, the procedure provides a better cosmetic effect,especially in young women.The subaxillary minithoracotomy is as safe and effective as median sternotomy in the repair of simple congential heart defects in children.