Repair of cardiac defects through a shorter right lateral thoracotomy in children

Background. Median sternotomy is a conventional approach for correction of cardiac defects for many years; however, the cosmetic result is poor. Therefore, right lateral thoracotomy was tested as an alternative procedure with a better cosmetic outcome. Methods. Between October 1994 and February 1999, 683 patients underwent correction of congenital cardiac malformations during a cardiopulmonary bypass through right lateral thoracotomy involving a shorter incision through the third or the fourth intercostal space. All of the patients were children. The average age was 3.26 ± 1.67 years (range, 4 months to 7 years). The average weight was 13.59 ± 4.37 kg (5 to 40). The patients had various cardiac defects and associated anomalies. Results. Only 2 patients died after operation, 1 from low cardiac output and the other from severe pulmonary infection. The hospital morbidity was lower. The mean cardiopulmonary bypass time was 58.67 ± 35.11 minutes (range, 16 to 430 minutes), the mean aortic cross-clamping time was 35.03 ± 24.84 minutes (range, 3 to 205 minutes). The postoperative average mechanical ventilation time was 19.23 ± 39.11 hours (range, 2 to 391 hours), and the mean postoperative stay was 8.55 ± 12.54 days (range, 5 to 293 days). Conclusions. The right lateral thoracotomy incision is a safe and effective alternative to a median sternotomy for correction of cardiac defects. Advantages of this approach compared with median sternotomy are less injury, maintenance of the continuity and the integrity of the bony thorax, and prevention of the development of “pigeon-chesting.” The scar is less visible, hence, the cosmetic result can meet patient expectations. This procedure is consistent with the idea of minimal invasive surgery.