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Can Ventricular Septal Defect Repair Be Performed Without Median Sternotomy? Evidence From An All-age Cohort
weijie liang, Heqi Zhang, Hua Cao, Haoju Dong, Taibing Fan.
Central China Fuwai Hospital of Zhengzhou University, Zhengzhou City, Henan Province, China.
BACKGROUND:This study aimed to evaluate a simplified minimally invasive surgical approach using a modified right vertical infra-axillary thoracotomy(MRVIAT) under central cardiopulmonary bypass for ventricular septal defect(VSD) repair across all age groups.
METHODS:This retrospective study included 1,212 patients with VSD who underwent repair via MRVIAT at our institution between January 2022 and December 2024.In all patients, the incision length ranged from 2 to 5 cm under central cardiopulmonary bypass.
RESULTS:All procedures were completed successfully, with no in-hospital mortality and no conversion to median sternotomy.The median age was 0.6 years (range, 18 days to 45 years), including 36 adults (3.0%).The median body weight was 7.0 kg (range, 1.8-105 kg), including 195 patients weighing ≤5 kg (16.1%) and 40 weighing ≥50 kg (3.3%).The median operative time was 100.0 minutes (interquartile range [IQR], 95.0-110.0), with a median cardiopulmonary bypass time of 46.0 minutes (IQR, 40.0-52.0) and a median aortic cross-clamp time of 27.0 minutes (IQR, 23.0-33.0).The median postoperative hospital stay was 6.0 days (IQR, 6.0-8.0).Major postoperative complications included residual shunt in 18 patients (1.5%), incision infection in 3 (0.3%), and pulmonary infection in 25 (2.1%).During a median follow-up of 1.3 years (range, 0.3-2.5 years), no thoracic deformity, moderate or severe valvular regurgitation, or surgery-related reintervention was observed.
CONCLUSIONS:The MRVIAT technique demonstrated favorable surgical outcomes with a low incidence of perioperative complications.Simplification and optimization of the surgical workflow may enhance the clinical value of MRVIAT and facilitate its broader application in minimally invasive congenital cardiac surgery.
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