ArticleBMC surgery2025
Short-term outcomes of atrial septal defect repair via right axillary incision in children: a single-center propensity-matched analysis.
Article in BMC surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundTo compare the short-term outcomes of atrial septal defect (ASD) repair via right axillary incision (RAI) versus median sternotomy (MS) in children.
methodsThis single-center, retrospective, controlled study aimed to compare the short-term outcomes of ASD repair performed via right axillary incision versus median sternotomy in children. The primary endpoint was the incidence of perioperative adverse events.
resultsA total of 162 pediatric patients (< 18 years) were included in this study, with 80 patients in the RAI group and 82 patients in the MS group. The overall mean age of enrolled patients was 4.9 years, and 73 (45.1%) patients of them were male. The RAI group had less intraoperative bleeding (P < 0.001), shorter ventilation time (P < 0.001), and lower drainage volume in 24 h (P < 0.001), with longer cardiopulmonary bypass time compared to the MS group (P = 0.004). The overall median follow-up time was 9.0 (7.0-15.0) months. There were no statistically significant differences between two groups in the incidence of perioperative adverse events [37(46.3%) vs. 42 (51.2%); P = 0.527]. During propensity score matching, 47 patients from the RAI group and 52 from the MS group were successfully matched. After match, the RAI group exhibited longer cardiopulmonary bypass time (P = 0.008), less ventilation time (P = 0.043) and lower drainage volume in 24 h (P < 0.001). No patient from either group still had residual shunt during the last follow-up. 2 (2.4%) patients in the MS group developed new-onset arrhythmias after surgery. Weight and age were identified as potential predictors in assisting the decision-making between RAI and MS approaches.
conclusionThe RAI approach is a safe and feasible alternative to MS for pediatric ASD repair, with comparable short-term outcomes. Although associated with longer CPB time, RAI may reduce surgical trauma in selected patients. Younger age and lower body weight may serve as preliminary indicators for RAI suitability.
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