# Vertical Right Axillary Thoracotomy for Repair of Ventricular Septal Defects in Infants and Children: Experience with 50 Consecutive Cases

## TL;DR

This study shows that a right axillary thoracotomy is a safe and effective alternative to traditional sternotomy for repairing heart defects in children.

## Contribution

The paper presents a large single-center experience demonstrating the safety and cosmetic benefits of right axillary thoracotomy for ventricular septal defect repair in children.

## Key findings

- All 50 patients underwent successful ventricular septal defect repair via right axillary thoracotomy with no conversions to sternotomy.
- The approach was associated with no early or late mortality, short hospital stays, and high patient and parental satisfaction with cosmetic outcomes.

## Abstract

Objectives: Recently, there has been a growing interest in repairing congenital heart defects in children via right axillary thoracotomy. We sought to review our experience with ventricular septal defect closure through this approach. Patients and Methods: This is a retrospective single-center analysis of 50 children who underwent closure of ventricular septal defects via vertical right axillary thoracotomy between March 2018 and February 2024. We reviewed the patients’ characteristics, perioperative and follow-up data. Results: The study included 26 (52%) girls with a median age of 7 (1–132) months. All patients underwent vertical right axillary thoracotomy with no conversion to sternotomy. Membranous ventricular septal defect was the most common diagnosis and was present in 43 (89%) patients. The median cardiopulmonary bypass and aortic cross clamp times were 96.5 (47–157) and 73 (30–114) min, respectively. In 45 (90%) of the patients, a patch was used. No early or late mortality. All patients were extubated in the operating room, and the median length of hospital stay was 2 (1–321) days. One early reoperation for bleeding, and one patient needed a permanent pacemaker. No late reoperations and all patients/parents were pleased with the incision. Conclusions: The outcomes of the right axillary thoracotomy for repairing ventricular septal defects in children are excellent. The approach is safe and is associated with superior cosmetic results and very short hospital stay. It should be strongly considered as an alternate to sternotomy for closure of ventricular septal defects.