Minimally invasive axillary repair, also referred to as cosmetic right axillary thoracotomy, is an advanced treatment approach involving a minimally invasive surgical technique for the repair of many congenital heart defects (CHDs) in children. As compared to traditional open heart surgery, this approach allows for faster functional recovery with superior cosmetic results – a small vertical scar on a patient’s side under the right arm instead of a large scar down the middle of the chest.
The procedure is used to repair defects accessible through the right atrium, including closure of ventricular septal defects (VSD), atrial septal defects (ASD), partial atrioventricular canal defects with mitral cleft, and partial anomalous pulmonary venous repair (PAPVR). Patients as young as a few months old (> 5kg) may be eligible for minimally invasive axillary repair.
This minimally invasive surgical approach is used to repair congenital heart defects that cannot be treated by a cardiologist in the catheterization lab and is less invasive than traditional open heart surgery. By avoiding a median sternotomy (cutting the breastbone), it spares muscles and does not interfere with the growth of breast tissue, which is especially important in young girls. The procedure generally results in a shorter hospital stay, favorable cosmetic results and a faster recovery.
By utilizing this surgical technique, the child’s recovery time is reduced from 4 to 6 weeks in younger children and 6 to 8 weeks in larger children, to typically less than a week. This innovative approach has produced positive outcomes among infants, children and adolescents, who are able to return to normal activity in days instead of weeks.
The surgeon approaches the heart through the third or fourth rib on the right side, and the right atrium is used as a window of repair to the heart (as is opposed to a median sternotomy in the middle of the chest). Typically, this procedure repairs the heart defect in one operation, and an echocardiography scan can confirm the quality and completeness of the repair. The approach results in an incision that is hidden by the resting arm in a standing child. In other words, the child’s heart is repaired with no visible, middle-of-the-chest scar that is typically associated with a heart condition.
While striving to deliver optimal results for each patient, the affiliated surgeons at Children’s Heart Institute work to ensure the quality of CHD repair is not compromised when compared to repairs done through a standard median sternotomy.
At Children’s Heart Institute, the affiliated team tailors each plan of care to help ensure that every child receives the best individualized option with the minimum amount of risk. Along with a thorough review of pediatric imaging results, the team provides a comprehensive evaluation of each patient and consults with the patient’s family to determine the best treatment approach for the child. Each child is evaluated to determine if he or she is a candidate for a minimally invasive axillary repair of their congenital heart defect.
For patients who meet the criteria to undergo a minimally invasive axillary repair, the benefits of this treatment approach include a reduced chance of complications from heart surgery and the potential to improve long-term quality of life. As there are risks associated with all treatment options, the affiliated team provides patient families with in-depth information on the risks and benefits of this approach. Not all patients qualify for this procedure, but each child will be carefully evaluated in an effort to find hope and solutions.
Below is a list of heart conditions that may be treated using the minimally invasive axillary repair in children who qualify:
After postoperative hospital discharge (with an average stay of 3 to 5 days), children are seen once at the UT Physicians Pediatric Cardiovascular Surgery Clinic, affiliated with Children’s Memorial Hermann Hospital, to confirm the quality of the repair by echocardiography, check on satisfactory wound healing and adjust medications, if needed. Patients may return to their personal pediatric cardiologist for further follow-up as needed, or be followed by the team of affiliated physicians at Children’s Heart Institute, according to the wishes of each patient’s family. The team individualizes care to the needs and anatomy of each child.
At Children’s Heart Institute at Children’s Memorial Hermann Hospital, patients with congenital or acquired heart disorders receive hands-on specialized care 24/7 from a team of affiliated physicians and specialty-trained nurses who aim to deliver the best possible outcomes.
Children’s Memorial Hermann Hospital was named one of the top 50 best children's hospitals nationally in Cardiology & Heart Surgery by U.S. News & World Report, and Children’s Heart Institute earned the distinguished three-star rating from The Society of Thoracic Surgeons (STS) for patient care and outcomes in congenital heart surgery. As one of only 12 three-star programs, Children’s Heart Institute ranks among the elite in the United States and Canada for congenital heart surgery.
In collaboration with various subspecialties, the affiliated team provides comprehensive care for newborns, children and adolescents, with the ability to transition into adult congenital cardiac care. Team members have the experience and skills necessary to offer innovative treatment methods and specialized services, including, but not limited to:
With the Level IV Neonatal Intensive Care Unit (NICU) and a dedicated Children’s Heart Institute Intensive Care Unit at Children’s Memorial Hermann Hospital, critical heart patients have access to quality, specialized care. By utilizing state-of-the-art techniques, the team at Children’s Heart Institute strives to offer patients with the most complex problems the greatest opportunity for a normal life.
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The Children’s Heart Institute at Children’s Memorial Hermann Hospital is affiliated with the physicians at McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth) and the UT Physicians Pediatric Outpatient Clinics across Greater Houston. Affiliated physicians evaluate patients at UT Physicians clinic locations and perform all inpatient procedures and treatments at Children’s Memorial Hermann Hospital.