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Minimally Invasive Repair Of Sinus Venosus Atrial Septal Defects And Anomalous Pulmonary Venous Connections Via Right Axillary Thoracotomy
Yasin Essa, MBBCh1, Ali Mashadi
1, Kristin Greathouse
2, Nicholas Brown
3, Joseph Giamelli
4, Sameh M. Said, MBBCh, MD
1.
1Westchester Medical Center, Valhalla, NY, USA,
2M Health Fairview, Minneapolis, MN, USA,
3University of Minnesota, Minneapolis, MN, USA,
4Boston Children's Health Physicians, Valhalla, NY, USA.
Objectives: to evaluate the feasibility and outcomes of vertical right axillary thoracotomy (VRAT) as an alternative approach for repair of sinus venous defects (SVDs) with or without anomalous pulmonary venous connections (APVCs).
Methods: Between April 2018 and Feb 2024, 23 consecutive patients underwent surgical repair of SVDs and APVCs via VRAT. Echocardiographic, operative, and clinical follow up data were obtained.
Results: The median age and weight were 36 months (range: 1-277 months), and 14.4 kg (range, 3.6 -79.4 kg) respectively. Almost half of patients were males (10; 43.5%). All repairs were done through VRAT with no conversion to sternotomy. Partial APVCS was the most frequent primary diagnosis (14; 60.9%), followed by scimitar syndrome (3; 13%), while two patients (8.7%) had total APVCs to the coronary sinus. Repair techniques included single patch in 10 patients (43.5%), Warden in 6 (26.1%), Two-patch technique in 4 (17.4%) and 3 (13%) patients underwent repair of scimitar syndrome. The median cardiopulmonary bypass and aortic cross clamp times were 91 (48-257) and 62 (31-196) minutes, respectively. All patients were extubated in the operating room. The median length of hospital stays was 2 (1 -6 days). There was no early or late mortality, and no re-operation for pulmonary/systemic venous pathways obstruction. Two (8.6%) Warden patients had mild superior vena caval gradient during the follow-up.
Conclusions: SVDs with/or without APVCs can be repaired safely via a vertical right axillary thoracotomy with excellent outcomes and is associated with superior cosmetic results and short hospital stay.
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