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Minimally Invasive, Maximally Effective: Vertical Right Axillary Thoracotomy For Repair Of Heart Defects In Neonate And Infants Under 5 Kg
Sameh M. Said, MBBCh, MD, MBA1, Yasin Essa1, Joseph Giamelli, MD2, Alexander Mittnacht1, Eric Fethke, MD2, Jeffrey Vergales, MD2.
1Westchester Medical Center, Valhalla, NY, USA, 2Boston Children Health Physicians, Valhalla, NY, USA.
ObjectivesVertical right axillary thoracotomy(VRAT) has become our preferred minimally invasive approach for repairing congenital heart defects(CHDs) in infants and children. This study evaluates the safety, efficacy, and clinical outcomes of VRAT specifically in neonates and infants weighing less than 5 kilograms, a group where minimally invasive techniques are seldom utilized.
Methods Between March 2018 and May 2024, 18 neonates and infants (<5 kg) underwent CHD repair via VRAT at our institution. Data on baseline demographics, perioperative details, echocardiographic findings, and follow-up outcomes were collected and analyzed.
Results The median age and weight were 3 months (range 0-6 months) and 4.6 kg (3.6-4.8 kg) respectively with 8(44.4%) being males. Procedures included predominantly ventricular septal defect repairs (14;77.8%), with atrial septal defect closure and total anomalous pulmonary venous connection repair each accounting for 2(11.1%). All surgeries were completed via VRAT with no conversions to sternotomy. Median cardiopulmonary bypass and aortic cross-clamp times were 80(36-148) and 61.5(18-97) minutes, respectively. Hospital stay was brief, median 2.5 days. There were no early or late mortalities, no reoperations, and no pacemaker implantations. After a median follow-up of 51 months (1-96 months), all patients showed excellent clinical outcomes. Parents reported high satisfaction with the cosmetic results and fast recovery.
Conclusions VRAT is a safe and effective approach for CHD repair in neonates and infants under 5 kg, providing excellent clinical outcomes, rapid recovery, and superior cosmetic satisfaction. This technique represents a valuable, less invasive alternative to sternotomy in this vulnerable population.
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