Safety And Efficacy Of Right Vertical Infraaxillary Thoracotomy In The Treatment Of Ventricular Septal Defect Of Infants

Objective: To compare the results of right vertical infraaxillary thoracotomy and standard median sternotomy in the repair of ventricular septal defect in infants,and to explore whether right vertical infraaxillary thoracotomy was equally safe and effective in infants compared with the standard median sternotomy within 1 year old patients.Methods:441 cases of ventricular septal defect(VSD)were divided into four groups by age,and all of them were treated by right vertical infraaxillary thoracotomy(RVIAT)in the Department of Cardiothoracic surgery,affiliated Children’s Hospital of Shanghai Jiaotong University.These groups were less than 1 year old RVIAT group(R1 group,N1 =123),1 ～2-year-old RVIAT group(R2,N2 =106),2 ～5-year-old RVIAT group(R3,n3 =166),> 5-year-old RVIAT group(R4,n4 =46).In the same period,there were 52 cases of infants with VSD treated by median sternotomy(SMS),all of whom were less than 1 year old,which was the SMS group(S1 group,n5 =52).And there were 493 cases in the whole group.All patients were confirmed by echocardiography.After comparing operation and post-operation between RVIAT four groups and R1 and S1 groups,the indicators were as follows:operation time,cardiopulmonary bypass(CPB)time,aortic cross-clamping time,intraoperative blood loss and postoperative ventilator-assisted ventilation time.Postoperative detention time in cardiac intensive care unit(CICU),postoperative hospital stay,the volume of thoracic drainage within 24 hours after operation,the total volume of blood transfusion and postoperative complications,and the follow-up results of 3 months after operation were followed up.The above clinical data were statistically analyzed by SPSS 22.0,the difference was statistically significant(P < 0.05).Results: The operation was successful and no serious complications were found in the all groups.There was no significant difference in operation time,intraoperative blood loss and thoracic drainage within 24 hours after operation among RVIAT groups(P > 0 05).In terms of cardiopulmonary bypass time,aortic cross-clamping time and postoperative CICU retention time,the time of R1 and R2 were longer than those of R3 and R4 groups,and there was significant difference between the two groups(P < 0.05).The duration of postoperative ventilator was longer in R1 group than that in R2,R3 and R4 groups(P< 0.05),the length of hospital stay and blood transfusion in R1 group were longer than that in R3 and R4 groups(P< 0.05),and the incidence of postoperative complications in R4 group was higher than that in R1 and R3 group(P < 0.05).There was no significant difference in the total operation time between group R1 and group S1,but the time of cardiopulmonary bypass and aortic cross-clamping were longer in group R1 than those in group S1.Postoperative retention time of CICU and ventilator time in group R1 were longer than those in group S1(P < 0.05).The amount of blood loss in group R1 was less than that in group S1,but there was no statistical difference between them(P > 0.05).The volume of thoracic drainage 24 hours after operation,the volume of blood transfusion and postoperative complications in group R1 were significantly lower than those in group S1(P < 0.05).Conclusions:1.RVIAT VSD repair in infants more than 4 months old was safer than those after SMS.Compared with those after SMS,postoperative CICU,postoperative ventilator-assisted ventilation,postoperative hospital stay were shorter.Thoracic drainage volume 24 hours after operation and the volume of blood transfusion in RVIAT were found to be less than those after SMS.The incidence of postoperative complications was lower in those after RVIAT VSD repair.RVIAT VSD repair was better than SMS VSD repair in a certain extent.2.There was no significant differences in the curative effect of RVIAT VSD repair in children between 4 months to 2 years of age,with the exception of postoperative ventilator-assisted ventilation time,of which in patients over 4 months old was longer than those in 1～2 years old.3.RVIAT VSD repair may be more effective in children over 2 years of age than in children aged 4months to 2 years.Among children over 2 years old,the incidence of postoperative complications was lower in 2～5-year-old children than in children over 5 years old.4.The application of RVIAT VSD repair in children aged 2 ～5 years old may be more effective.