Comparison between minimal right vertical infra-axillary thoracotomy and standard median sternotomy for repair of atrial septal defects

Background: The minimal right vertical infra-axillary thoracotomy could be a safe and cosmetic alternative to standard median sternotomy. This study reviews our results and experience with a minimal right vertical infra-axillary thoracotomy technique for the repair of atrial septal defects compared with standard median sternotomy. Methods: The study was designed as a retrospective, observational, and case-controlled study. Between May 2007 and November 2012, 26 patients underwent atrial septal defect closure with standard median sternotomy (Group 1). This group was compared with 21 patients who underwent repair of atrial septal defects using minimal right vertical infra-axillary thoracotomy (Group 2). Quantitative data were given as mean ± standard deviation, and qualitative values were expressed as percentages. In the comparison of the normal variables between the two groups, we used independent sample t test, and in the comparison of categorical variables between groups, Chi-square test was used. Results: The mean length of incision was significantly shorter in Group 2 than in Group 1 (p = 0.03). The time it took to establish cardiopulmonary bypass was longer in Group 2 (p = 0.04). There were no statistically significant differences in cardiopulmonary bypass time (p = 0.11), aortic cross-clamp time (p = 0.10), and total operation time (p = 0.10) between the two groups. Group 2 had less chest tube drainage (p = 0.04), less blood transfusion (p = 0.02), and shorter postoperative mechanical ventilation time (p = 0.09) than Group 1. Conclusion: Minimal right vertical infra-axillary thoracotomy can be performed with favorable cosmetic and clinical results for atrial septal defects closure. Infra-axillary thoracotomy provides a good alternative to standard median sternotomy for patients with atrial septal defects