Right vertical infra-axillary mini-incision for repair of simple congenital heart defects: a matched-pair analysis

OBJECTIVES: To evaluate the efficacy and safety of the right vertical infra-axillary mini-incision (RVAI) used for the repair of simple congenital heart defects. METHODS: We performed a retrospective 1:1 matched-pair analysis on the patients with simple congenital heart defects who were operated on from February 2003 to October 2010. All the recruited patients were treated through either RVAI (RVAI group) or median sternotomy incision (MSI group). In order to balance the major prognostic factors between the two groups, the MSI group was selected by a pair-matched case–control methodology and matched for heart defects, the year of surgery, body weight and patching. RESULTS: A total of 104 patients were included. The demographics and preoperative clinical characteristics of the patients in the RVAI group (n= 52) and in the MSI one (n= 52) were similar. There were no operative or late mortalities and no special care in the intensive care unit (ICU) or rehospitalization. The mean duration time of surgical operation (skin-to-skin) was 147 ± 21 min (range from 100 to 190 min) in the RVAI group and 174 ± 35 min (range from 120 to 270 min) in the MSI one (P < 0.001), respectively. No significant difference was found between the two groups in the consuming time for cardiopulmonary bypass, aortic cross-clamp, postoperative ventilation, ICU stay, postoperative hospital stay and drainage. No significant residual defects were found in patients of both groups. No asymmetrical development of the breast, thoracic deformity or scoliosis has been found during the follow-up. All the patients or the parents of young children (100%) in the RVAI group and 34 patients or the parents of young children (65.4%) in the MSI one were satisfied with the cosmetic results (P< 0.001). CONCLUSIONS: The RVAI surgical approach to simple congenital heart defects was a safe procedure and could be performed with excellent cosmetic and clinical outcomes. It provided a good alternative to the standard MSI for simple congenital heart defects.