Right Axillary Thoracotomy in Congenital Cardiac Surgery: Analysis of Percutaneous Cannulation

Abstract

Background: Vertical right axillary minithoracotomy (VRAMT) represents a minimally invasive and cosmetically attractive alternative for selected congenital heart defects. We report our institutional experience with VRAMT, especially regarding the performance of percutaneous femoral venous access to establish extracorporeal circulation in this pediatric population.

Methods: A retrospective single-center analysis was made of children to 16 years of age who underwent corrective cardiac surgery using VRAMT over a period of 5 years. VRAMT involved a 4 cm to 5 cm vertical incision parallel to the anterior axillary fold and aortic/bicaval cannulation. Since 2016, the technique has been modified and the inferior vena cava was cannulated using femoral percutaneous venous access. The primary endpoints were all-cause mortality, with additional secondary endpoints of major adverse cardiac and cerebrovascular events and conversion to median sternotomy.

Results: A total of 110 patients with biventricular congenital malformations were included. Age was 2.3 years (range, 0.2 to 16), and body weight was 11 kg (range, 3 to 47). Extracorporeal circulation time was 66 minutes (range, 24 to 167), cross-clamp time was 41 minutes (range, 9 to 95). Fast-track-management with on-table extubation was achieved in 34.5% (n = 38). For patients with percutaneous femoral venous cannulation (n = 38, 34.5%), thrombosis at the cannulation site was recorded in 5 cases (13.5%). There was no early or late mortality during the follow-up of 14.4 months (range, 0.8 to 47.19). No wound infection or thoracic deformities were observed.

Conclusions: VRAMT can be considered as an alternative, minimally invasive, and cosmetically attractive access for the repair of frequent congenital heart defects in newborns and young children. Percutaneous femoral venous cannulation provides sufficient extracorporeal circulation flow and can be used even in infants with early postoperative heparin prophylaxis.