Department of Cardiac Vascular Surgery, Yan An Hospital of Kunming City, Kunming, 65000, Yunnan, China.
J Cardiothorac Surg. 2024 Oct 3;19(1):587. doi: 10.1186/s13019-024-03105-y.
To compare the therapeutic effects of right vertical infra-axillary thoracotomy (RVIAT) and Standard Median Sternotomy (SMS) in the repair of atrial septal defect (ASD) and ventricular septal defect (VSD), and to evaluate the safety and effectiveness of right subaxillary incision technique in the surgical treatment of common congenital heart disease (CHD) in children.
Data of children diagnosed with ASD repair or VSD repair at our center from September 2019 to September 2022 were collected. Based on propensity score matching, 214 children (107 in the RVIAT group and 107 in the SMS group) who completed ASD repair surgery and 242 children (121 in the RVIAT group and 121 in the SMS group) who completed VSD repair surgery were selected for the study. The perioperative and follow-up data of the two surgical approaches were compared to evaluate clinical efficacy.
There was no statistically significant difference (p > 0.05) between the two surgical approaches in terms of surgical time, aortic occlusion time, total amount of ultrafiltration fluid, ICU stay time, and hospital stay; The intraoperative blood loss and total postoperative drainage fluid in the RVIAT group were lower than those in the SMS group (p < 0.05); The incidence of postoperative thoracic deformities in the SMS group is higher than that in the RVIAT group.
The safety and effectiveness of the two approaches are similar, but RVIAT has less intraoperative bleeding, less postoperative drainage fluid and tube time, and better concealment and cosmetic effects, which is worthy of further clinical promotion and application.
比较右垂直腋下小切口（RVIAT）和标准正中胸骨切开术（SMS）在房间隔缺损（ASD）和室间隔缺损（VSD）修复中的治疗效果，评估右腋下小切口技术在儿童常见先天性心脏病（CHD）手术治疗中的安全性和有效性。
收集我院 2019 年 9 月至 2022 年 9 月诊断为 ASD 修补术或 VSD 修补术的患儿资料，采用倾向性评分匹配法，选择完成 ASD 修补术的患儿 214 例（RVIAT 组 107 例，SMS 组 107 例），完成 VSD 修补术的患儿 242 例（RVIAT 组 121 例，SMS 组 121 例），比较两种手术方式的围术期及随访资料，评价临床疗效。
两种手术方式在手术时间、主动脉阻断时间、总超滤量、住 ICU 时间、住院时间方面比较，差异无统计学意义（P>0.05）；RVIAT 组术中出血量、总术后引流量均少于 SMS 组（P<0.05）；SMS 组术后胸廓畸形发生率高于 RVIAT 组。
两种术式的安全性和有效性相当，但 RVIAT 术中出血少、术后引流液少、置管时间短，且隐蔽性和美容效果更好，值得进一步临床推广应用。
