Right AxillaryThoracotomy vs.Median Sternotomy for Repair of Congenital Heart Defects in Infants and Children  

作　　者：Sameh M.Said Kristin C.Greathouse Christina McCarthy Megan Khan Molly Hagen Nicholas Brown Sacha Kumar Mahmoud I.Salem James Flaherty Yasin Essa 

机构地区：[1]Division of Pediatric and Adult Congenital Cardiac Surgery,Department of Surgery,Maria Fareri Children’s Hospital,Westchester Medical Center,New York Medical College,Valhalla,NY 10595,USA [2]Department of Cardiothoracic Surgery,Faculty of Medicine,Alexandria University,Alexandria,21321,Egypt [3]Division of Pediatric Critical Care,M Health Fairview Health System,Masonic Children’s Hospital,Minneapolis,MN 55454,USA [4]Division of Pediatric Anesthesia,M Health Fairview Health System,Masonic Children’s Hospital,Minneapolis,MN 55454,USA [5]Division of Pediatric Critical Care Medicine,Department of Pediatrics,Masonic Children’s Hospital,University of Minnesota,Minneapolis,MN 55454,USA [6]Department of Cardiothoracic Surgery,Port Said University,Port Said,42523,Egypt [7]Department of Anesthesiology,University of Minnesota,Minneapolis,MN 55454,USA

出　　处：《Congenital Heart Disease》2024年第6期563-575,共13页先天性心脏病(英文)

摘　　要：Objective:Vertical right thoracotomy(VRAT)has become an alternative to sternotomy for the repair of non-complex congenital heart defects in our infants and children.Summary Background Data:Limited data exists on the comparison of the two approaches.Methods:The present study consisted of two groups;Group Ⅰ:(sternotomy;33 patients)and Group Ⅱ:(VRAT;35 patients).We compared the two groups on operative data,hours of invasive lines,narcotics used,length of stay,and total variable cost of stay.Results:The most frequent procedures were atrial and ventricular septal defect closure(25 patients,75.8%in Group Ⅰ)and(14 patients,40%in Group Ⅱ).The average age and weight were 33.43±53 months,and 14.7±16.9 kg for Group I,and 75.3±60.2 months and 24.9±18 kg for Group Ⅱ,respectively,(p<0.001).We found no differences in aortic cross-clamp/bypass times between groups(p=0.39 and 0.42,respectively).The use of narcotics was not significantly different between the two study groups(p=0.37)as was the total variable cost(p=0.115).Group Ⅱ had a lower time without invasive lines(p<0.001).In Group Ⅱ the total length of stay was significantly less as well(p<0.001).Conclusions:VRAT is a useful technique for repairing a wide range of heart defects and does not result in prolonged cardiopulmonary bypass or aortic cross-clamp times.Although total opioid use and total cost of stay are no different as with sternotomy,the shortened duration of invasive line use,and shorter length of stay make this approach worthy of consideration.

关 键 词：Minimally invasive cardiac surgery congenital heart defects right thoracotomy vertical axillary right thoracotomy axillary thoracotomy 

分 类 号：R54[医药卫生—心血管疾病]