Switch arterial tardío, sin preparación previa ni oxigenador de membrana extracorpórea de soporte / Late arterial switch, without previous preparation or extracorporeal membrane oxygenation back-up

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Cirugía mínimamente invasiva en niños. Corrección de la comunicación interauricular por vía axilar y submamaria / Minimally invasive pediatric cardiac surgery. Atrial septal defect closure through axillary and submammary approaches

Introducción y objetivos. Los accesos mínimamente invasivos en cardiopatías no complejas ofrecen alternativas que disminuyen las secuelas estéticas. Asimismo, la cirugía se indica en edades más tempranas. En trabajos previos, comparamos la incisión submamaria con la esternotomía media. Presentamos nuestra experiencia inicial en el acceso axilar para el cierre de las comunicaciones interauriculares con circulación extracorpórea en comparación con el acceso submamario. Métodos. Se recoge en total a 20 pacientes: 10 casos por vía submamaria derecha (7 ostium secundum, 2 seno venoso, 1 ostium primum) y 10 casos operados a través de la axila derecha (7 ostium secundum, 3 seno venoso). Las medias de edad y de peso eran 6,4±3,62 (3-13) años y 23,5±8,74 (12-38) kg en el grupo submamaria y 5,5±2,04 (3-9) años y 19,7±5,88 (14-29) kg en el grupo axilar. En todos ellos, el procedimiento (canulación y corrección) se realiza completamente a través de la propia incisión respetando grupos musculares, sin puertos complementarios. Resultados. No se registran defectos residuales en la ecografía de control al alta. Ningún caso precisó reconversión a esternotomía media. Las maniobras de abordaje y canulación axilares son algo más complejas que las submamarias. Los tiempos de circulación extracorpórea y pinzamiento son superponibles en ambos grupos, comparados por enfermedades (p>0,05). Conclusiones. En pacientes seleccionados y con defectos abordables a través de la aurícula, la vía axilar derecha es tan segura como la submamaria. El resultado estético es excelente(AU)

Introduction and objectives: Minimally invasive approaches in less-complex cardiac procedures can avoid unpleasant cosmetic results. Moreover, surgery can be scheduled in younger patients. In previous papers, we compared submammary and midline sternotomy.We present our initial experience with an axillary, compared to submammary, approach to repair atrial septal defects under extracorporeal circulation. Methods: 20 patients are included: 10 in the submammary group (7 ostium secundum, 2 sinus venosus, 1 ostium primum) and 10 in the axillary group (7 ostium secundum, 3 sinus venosus). Mean age and weight are 6.4 +/- 3.62 years (range 3-13) and 23.5 +/- 8.74 Kg (range 12-38) in the submammary group, and 5.5 +/- 2.04 years (range 3-9) and 19.7 +/- 5.88 Kg (range 14-29) in the axillary one, respectively. Muscles are spared (pectoralis in submammary and latissimus in axillary). The whole procedure (cannulation and correction) is performed through a single incision, with no side ports. Results: No residual defects were found at discharge. Surgical approach maneuvers are more cumbersome through the axillary than the submammary approach. In a peer comparison, extracorporeal circulation and cross-clamp time were similar in both groups (P > .05). Conclusions: 1. Axillary approach is as safe as submammary access in selected patients and for defects approached through the atrium. 2. Cosmetic result is excellent(AU)

Minimally invasive pediatric cardiac surgery. Atrial septal defect closure through axillary and submammary approaches.

INTRODUCTION AND OBJECTIVES: Minimally invasive approaches in less-complex cardiac procedures can avoid unpleasant cosmetic results. Moreover, surgery can be scheduled in younger patients. In previous papers, we compared submammary and midline sternotomy. We present our initial experience with an axillary, compared to submammary, approach to repair atrial septal defects under extracorporeal circulation. METHODS: 20 patients are included: 10 in the submammary group (7 ostium secundum, 2 sinus venosus, 1 ostium primum) and 10 in the axillary group (7 ostium secundum, 3 sinus venosus). Mean age and weight are 6.4±3.62 years (range 3-13) and 23.5±8.74 Kg (range 12-38) in the submammary group, and 5.5±2.04 years (range 3-9) and 19.7±5.88 Kg (range 14-29) in the axillary one, respectively. Muscles are spared (pectoralis in submammary and latissimus in axillary). The whole procedure (cannulation and correction) is performed through a single incision, with no side ports. RESULTS: No residual defects were found at discharge. Surgical approach maneuvers are more cumbersome through the axillary than the submammary approach. In a peer comparison, extracorporeal circulation and cross-clamp time were similar in both groups (P>.05). CONCLUSIONS: 1. Axillary approach is as safe as submammary access in selected patients and for defects approached through the atrium. 2. Cosmetic result is excellent.