Guest Editor Series: Right Axillary Thoracotomy for Repair of a Wide Variety of Congenital Heart Defects in Infants and Children—Should This Be the New Standard?

In the newest CTSNet Guest Editor Series, “Right Axillary Thoracotomy for Repair of a Wide Variety of Congenital Heart Defects in Infants and Children—Should This Be the New Standard?” Dr. Sameh Said brought together congenital cardiac surgery experts from around the world to contribute procedure videos on right axillary thoracotomy for repair of congenital heart defects. 

This series features contributor videos from four global cardiothoracic surgeons, which can be found at the bottom of this page as they are released from August 21-24, 2023, concluding with a webinar to be aired live on August 25, 2023.

In this webinar, Dr. Said and three contributors discuss the merits of this approach for a variety of procedures, as exemplified in the surgical cases published as part of this Guest Editor Series.
 

Webinar Recording

Dear CTSNet Reader,

Surgical techniques for repair of congenital heart defects have evolved over the years with significant reduction in mortality and morbidity. Median sternotomy has been the gold standard approach for decades. On one hand, it allows access to all mediastinal structures and provides safe cannulation and conduct for cardiopulmonary bypass, but on the other hand, it has several drawbacks that include invasiveness, wound-related complications, slow return to full activity, and the visible scar that results in patients’ and parents’ dissatisfaction. 

The progress in minimally invasive approaches for infants and children with heart defects has been lagging in comparison to adults, where minimally invasive approaches have been the standard for valve repair and replacement and coronary artery bypass grafting.

Right axillary thoracotomy has emerged as a valuable approach for repair of a wide variety of heart defects in infants and children. However, this approach is not gaining the popularity it deserves because of several myths that surround the approach, such as safety, adequacy of exposure, and the possibility of musculoskeletal and/or breast deformities as the child grows up.

The axillary thoracotomy approach requires a learning curve, but in expert hands it is without a doubt superior to sternotomy in terms of the cosmetic aspect, the significantly shorter length of hospital stay, and the rapid return to full activity without any restrictions. 

A variety of heart defects can be repaired through this approach, such as all types of atrial septal defects, partial anomalous pulmonary venous return and connections, most ventricular septal defects, subaortic membrane, mitral, and tricuspid valve repairs, and more. 

I selected this interesting topic for this Guest Editor Series series and related webinar to highlight the tips and pitfalls for the axillary thoracotomy and to clarify several of the myths surrounding this approach and causing patients and providers confusion in terms of safety and efficacy.

This series includes videos of four different heart defects repaired via right axillary thoracotomy by four of the world experts in utilizing this approach. Each contributor has hundreds of cases under their belt using this approach.

Two of the videos show the vertical and the other two show the horizontal versions of the axillary approach. First, Dr. Julie Cleuziou from the German Heart Center in Munich demonstrates her technique for repairing a large secundum atrial septal defect using fibrillatory arrest. Dr. Ali Dodge-Khatami from University Hospital RWTH in Aachen, Germany shows excellent tips and pitfalls when utilizing the right thoracotomy for closure of membranous ventricular septal defect. 

Next, Dr. Oleksandr Babliak from the Diagnostic and Treatment Center for Children and Adults of The Dobrobut Medical Network in Kyiv, Ukraine, shows a very challenging case of repair of anomalous left coronary artery origin from the pulmonary artery (ALCAPA) and mitral valve repair in a one-year-old girl. Finally, my team and I demonstrate our technique for repairing a sinus venous septal defect and partial anomalous pulmonary venous connection using a two-patch technique.    
 
It is our hope that this special seriespositively impacts the care of infants and children with congenital heart defects and provides the necessary knowledge needed for utilization of the right axillary thoracotomy approach in children. 

Sameh M. Said, MBBCh, MD, FACC, FACS

Contributor Videos

1.    ASD Closure Through a Midaxillary Minithoracotomy by Julie Cleuziou and Paul Phillipp Heinisch

2.    Minimally Invasive Right Axillary Thoracotomy for Ventricular Septal Defect Closure: Tips and Pitfalls by Ali Dodge-Khamati, Thai Duy Nguyen, and Andre Ruffer

3.    Intraatrial Baffle Repair of Partial Anomalous Pulmonary Venous Return Via Vertical Right Axillary Thoracotomy by Ali H. Mashadi, Yasin Essa, and Sameh M. Said

4.    Minimally Invasive Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery (ALCAPA) and Mitral Valve Repair in a Child by Oleksander Babliak, Dmytro Babliak, Demianenko Volodymyr, and Anton Marchenko

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