Department of Pediatrics, Division of Pediatric Cardiology, Southshore University Hospital, Bay Shore, USA.
Department of Cardiothoracic Surgery, Division of Pediatric and Congenital Heart Surgery, Cohen Children's Medical Center, New Hyde Park, USA.
Cardiol Young. 2022 Feb;32(2):276-281. doi: 10.1017/S1047951121001979. Epub 2021 May 21.
The mini right axillary thoracotomy is an alternative surgical approach to repair certain congenital heart defects. Quality-of-life metrics and clinical outcomes in children undergoing either the right axillary approach or median sternotomy were compared.
Patients undergoing either approach for the same defects between 2018 and 2020 were included. Demographic details, operative data, and outcomes were compared between both groups. An abbreviated quality of life questionnaire based on the Infant/Toddler/Child Health Questionnaires focused on the patient's global health, physical activity, and pain/discomfort was administered to all parents/guardians within two post-operative years.
Eighty-seven infants and children underwent surgical repair (right axillary thoracotomy, n = 54; sternotomy, n = 33) during the study period. There were no mortalities in either group. The right axillary thoracotomy group experienced significantly decreased red blood cell transfusion, intubation, intensive care, and hospital durations, and earlier chest tube removal. Up to 1 month, parents' perception of their child's degree and frequency of post-operative pain was significantly less after the right axillary thoracotomy approach. No difference was found in the patient's global health or physical activity limitations beyond a month between the two groups.
With the mini right axillary approach, surrogates of faster clinical recovery and hospital discharge were noted, with a significantly less perceived degree and frequency of post-operative pain initially, but without the quality of life differences at last follow-up. While providing obvious cosmetic advantages, the minimally invasive right axillary thoracotomy approach for the surgical repair of certain congenital heart lesions is a safe alternative to median sternotomy.
微创右腋下小切口是修复某些先天性心脏缺陷的另一种手术方法。比较了行右腋下入路或正中胸骨切开术的儿童的生活质量指标和临床结果。
纳入了 2018 年至 2020 年期间因相同缺陷行该两种入路的患者。比较了两组患者的人口统计学资料、手术数据和结果。术后两年内，所有父母/监护人都接受了基于婴儿/幼儿/儿童健康问卷的简短生活质量问卷，该问卷侧重于患者的整体健康、身体活动和疼痛/不适。
在研究期间，87 名婴儿和儿童接受了手术修复（右腋下小切口，n = 54；胸骨切开术，n = 33）。两组均无死亡病例。右腋下小切口组的红细胞输注、插管、重症监护和住院时间以及更早的胸腔引流管拔除明显减少。在术后 1 个月内，父母对其孩子术后疼痛程度和频率的感知明显小于右腋下小切口组。两组患者的全球健康或身体活动受限在 1 个月后均无差异。
采用微创右腋下入路，术后临床恢复和出院速度更快，术后初始疼痛程度和频率明显降低，但末次随访时生活质量无差异。微创右腋下小切口治疗某些先天性心脏病变的方法，除了具有明显的美容优势外，也是正中胸骨切开术的一种安全替代方法。
