Right axillary thoracotomy in congenital cardiac surgery: analysis of percutaneous cannulation.

Abstract Background Vertical right axillary mini-thoracotomy (VRAMT) represents a minimal-invasive and cosmetically attractive alternative for selected congenital heart defects. We report our institutional experience with VRAMT, especially regarding the performance of percutaneous femoral venous access to establish extracorporeal circulation in this pediatric population. Methods Retrospective single center analysis of children up to 16 years who underwent corrective cardiac surgery using VRAMT over a period of 5 years. VRAMT involved a 4-5 cm vertical incision parallel to the anterior axillary fold and aortic/bicaval cannulation. Since 2016, the technique has been modified and the inferior-vena-cava was cannulated using femoral percutaneous-venous-access. The primary endpoints were all-cause mortality with additional secondary endpoints of major adverse cardiac and cerebrovascular events (MACCE) and conversion to median sternotomy. Results A total of 110 patients with biventricular congenital malformations were included. Age was 2.3 (0.2-16) years and body weight was 11 (3-47) kg. Extracorporeal-circulation-time was 66 (24-167) minutes, cross clamp time was 41 (9-95) minutes. Fast-track-management with on-table extubation was achieved in 34.5% (n=38). For patients with percutaneous-femoral venous-cannulation (n=38, 34.5%), thrombosis at the cannulation site was recorded in 5 (13.5%) cases. There was no early or late mortality during the follow-up of 14.4 (0.8 – 47.19) months. No wound infection nor thoracic deformities were observed. Conclusions VRAMT can be considered as an alternative, minimal-invasive and cosmetically attractive access for the repair of frequent congenital heart defects in newborns and young children. Percutaneous-femoral-venous cannulation provides sufficient ECC flow and can be used even in infants with early postoperative heparin prophylaxis.