Prognostic analysis of children with tetralogy of Fallot through a small incision in the right axilla

TL;DR

This study compares two surgical approaches for treating tetralogy of Fallot in young children and finds that a minimally invasive method is as safe and effective as the traditional approach.

Contribution

The study demonstrates that a right axillary small incision is a viable alternative to median sternotomy for TOF surgery in children under 3.

Findings

Minimally invasive surgery showed shorter ventilator duration and ICU stay compared to traditional surgery.

Both surgical approaches had similar mortality and complication rates.

The minimally invasive approach reduced peritoneal dialysis rates and surgical trauma.

Abstract

Compare the clinical efficacy of a minimally invasive small incision in the right axilla vs. traditional median sternotomy in the surgical treatment of tetralogy of Fallot (TOF).

A retrospective analysis was conducted on 330 infants and young children under the age of 3 who underwent radical surgery for tetralogy of Fallot between March 2022 and March 2024. Patients were categorized into two groups based on the surgical approach. To ensure the consistency of preoperative baseline data (weight, gender, age, O2 saturation, main pulmonary artery and pulmonary branches diameter, McGoon ratio) between the two groups, the propensity score matching method was applied for 1:1 matching, resulting in two cohorts of 228 cases. The minimally invasive group (n = 114) received surgery through a small incision in the right axilla, while the median sternotomy group (n = 114) underwent surgery via median sternotomy. Clinical parameters including demographic data (weight, gender, age, O2 saturation, main pulmonary artery and pulmonary branches diameter, McGoon ratio), cardiopulmonary bypass metrics (duration of bypass, aortic cross-clamp time), duration of mechanical ventilation, intensive care unit (ICU) stay, postoperative chest drainage volume within 24 h, pulmonary valve regurgitation, and complications (reintubation, peritoneal dialysis, reoperation, extracorporeal membrane oxygenation (ECMO) use, infection, and mortality) were collected for comparison between groups.

No statistically significant differences were observed between the two groups in 24 h chest drainage volume, mortality, reintubation, reoperation, ECMO use, and infection. However, the minimally invasive group showed significantly shorter ventilator duration and ICU stay and a reduced rate of peritoneal dialysis (all p < 0.05).

In infants and children under 3 years old with TOF, surgical correction via a right axillary small incision achieves equivalent clinical outcomes to traditional median sternotomy, without increasing postoperative mortality or complication rates. In addition, the minimally invasive approach offers benefits of reduced surgical trauma and enhanced postoperative recovery.

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