Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People's Republic of China.
Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People's Republic of China.
Ann Thorac Surg. 2022 Mar;113(3):896-902. doi: 10.1016/j.athoracsur.2021.01.052. Epub 2021 Feb 13.
This study evaluated the surgical results of a diverse array of congenital heart defects through minimal right vertical infra-axillary incision (RVIAI).
We performed a retrospective review of consecutive patients using minimal RVIAI for congenital heart defects between 2015 and 2019. The study included 1672 patients and minimal RVIAI was used for 13 primary procedures. The incision was 2.0 to 4.0 cm in all patients.
Median age was 2.3 years (range, 0.2-6.0 years) and median weight was 12.5 kg (range, 5.0-34.0 kg). There were no in-hospital deaths or conversions to median sternotomy. Five patients underwent early reoperations (0.3%; 3 had postoperative bleeding, 1 had coarctation of ascending aorta owing to cannulation, and 1 had a major residual shunt). Other postoperative complications included a trivial residual shunt in 16 patients (1.0%), pleural effusion in 3 (0.2%), and wound infection in 4 (0.2%). Median follow-up was 3.2 years (range, 0.2-4.9 years). There were no late deaths or late reoperations. During follow-up, no surgery-related thoracic deformity or breast asymmetry was noted. One patient had mild scoliosis. We randomly chose 100 patients to complete a questionnaire regarding patient satisfaction with minimal RVIAI. Results showed that all patients and their parents were satisfied with the cosmetic results.
Minimal RVIAI can be safely performed for a wide range of congenital heart defects with excellent cosmetic results. It may serve as a good alternative to median sternotomy, especially for young female patients.
本研究通过微创右腋下垂直小切口（RVIAI）评估了多种先天性心脏缺陷的手术结果。
我们对 2015 年至 2019 年间使用微创 RVIAI 治疗先天性心脏缺陷的连续患者进行了回顾性分析。研究包括 1672 例患者，其中 13 例采用了 RVIAI 进行了主要手术。所有患者的切口长度为 2.0 至 4.0 厘米。
中位年龄为 2.3 岁（范围，0.2-6.0 岁），中位体重为 12.5 公斤（范围，5.0-34.0 公斤）。无院内死亡或转为正中胸骨切开术。有 5 例患者需要早期再次手术（0.3%；3 例术后出血，1 例因插管导致升主动脉缩窄，1 例存在主要残余分流）。其他术后并发症包括 16 例患者（1.0%）存在轻微残余分流、3 例患者存在胸腔积液（0.2%）和 4 例患者发生伤口感染（0.2%）。中位随访时间为 3.2 年（范围，0.2-4.9 年）。无晚期死亡或晚期再次手术。随访期间，无与手术相关的胸廓畸形或乳房不对称。1 例患者有轻度脊柱侧弯。我们随机选择了 100 例患者完成了一份关于对微创 RVIAI 满意度的调查问卷。结果显示，所有患者及其家长对美容效果均满意。
微创 RVIAI 可安全用于多种先天性心脏缺陷，美容效果极佳。它可能是正中胸骨切开术的良好替代方法，特别是对于年轻女性患者。
