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Mid-term results of right axillary incision for the repair of a wide range of congenital cardiac defects

^a Department of Congenital Cardiac Surgery, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland
^b Department of Cardiac Anaesthesia, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland

Received 3 September 2008; received in revised form 13 January 2009; accepted 14 January 2009.

^_* Corresponding author. Tel.: +41 44 2668003/2668020; fax: +41 44 2668021. (Email: hitendu{at}hotmail.com; hitendu.dave{at}kispi.uzh.ch).

Objective: We evaluated the mid-term results of the right axillary incision used for the repair of various congenital heart defects. Methods: All the patients who were operated with this incision between March 2001 and December 2007 were reviewed. There were 123 patients (median age 4.7 {0.4–19.4} years and median weight 16.6 {3.8–62} kg) undergoing atrial septal defect (ASD) closure (62), repair of partial anomalous pulmonary venous connection (PAPVC) (22), correction of partial atrioventricular septal defect (AVSD) (19), and restrictive perimembranous ventricular septal defect (VSD) (20). Additional procedures involved tricuspid valve plasty (10), mitral annuloplasty (3), reduction plasty of the aortic sinus (2), resuspension of the aortic valve cusp (2), sub aortic membrane resection (1), or reimplantation of Scimitar vein (1). The surgical technique involved peripheral (groin) and central (SVC ± aorta) cannulation for institution of cardiopulmonary bypass. Fibrillatory arrest was used for repair of ASDs and cardioplegic arrest for repairs involving the atrioventricular valves as well as VSDs. The median CPB and aortic clamp times were 72 (35–232) and 0 (0–126) min, respectively. Results: There was no need for conversion to another approach in any patient. Early morbidity included transient paresis of left upper arm (1), stenting of SVC after repair of a sinus venosus defect (1) and revision for bleeding (1). Follow-up echo showed no residual defect in 116 patients and minor residual defects in 7 patients: tiny ASD (2), tiny VSD (1) and mitral regurgitation (4). One patient developed stenosis in the right external iliac artery used for cannulation, necessitating surgical intervention. All the patients are in excellent condition after a median follow-up of 4.1 (0.4–7.1) years. The incision healed well and the thorax and the breast showed no deformity on follow-up. Conclusions: The right axillary incision provides a quality of repair for various congenital defects similar to that obtained by using standard surgical approaches. Because of its deceitful location, and the camouflaging effect of being hidden by the resting arm, it has superior cosmetic appeal compared to conventional incisions. The incision does not interfere with subsequent development of the thorax or the breast (in case of females).

Key Words: Minimally invasive congenital heart surgery • Muscle sparing thoracotomy • Right lateral minithoracotomy • Right axillary incision • External iliac artery and vein cannulation