Right thoracotomy for open-heart surgery of congenital cardiac anomalies Comparison of the results of ASD closure from right thoracotomy and median sternotomy

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Right thoracotomy for open-heart surgery of
congenital cardiac anomaliesComparison of the
results of ASD closure from right thoracotomy and
median sternotomy

• Cs. Tamás M.D.

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Right thoracotomy for open-heart surgery of
congenital cardiac anomalies
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Thoracotomy/Sternotomy Rates
2000 2001 2002
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Advantages of thoracotomy

• COSMETIC ISSUE
• No sternum osteomyelitis
• Lower intra/postoperative opiate requirement
  (paravertebral blockade)
• Increasing possibility of extubation in the
  operating room

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Disadvantages of thoracotomy

• Longer procedure time
• Difficulty of exploration and cannulation
• Danger of postoperative pneumothorax
• Danger of phrenic nerve palsies
• Thoracic adhesions

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Comparing of the respiratory time, ICU staying
and opiate requirement
Extub. Rate in the OR Respiratory time Opiate requirement PICU staying
Thoracotomy 50 2,06 hours 8,3 /- 4,1 mcg/kg 1 day
Sterno tomy 20 8,6 hours 11,2 /- 4,7 mcg/kg 1 day
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Complications in thoracotomy group

• Mortality
  0/46
• Residual ASD
  0/46
• Transient phrenic nerve palsy
  2/46
• Dehistency, suppuration
  1/46
• Transient sinus node dysfunction
  2/46
• Transient repol. Dysfunction
  2/46
• Postoperative pericardial fluidum
  1/46
• Transient tetraparesis, aeroembolysm
  1/46
• Pneumony
  1/46

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Complications in sternotomy group

• Mortality
  0/70
• Residual ASD
  0/70
• Postoperative bleeding,
  haematoma evacuation
  3/70
• Right ventricle dysfunction
  2/70
• Transient postoperative repol. Dysfunction
  3/70
• Postoperative ventricle fibrillation
  1/70
• Transient sinus node dysfunction
  3/70
• Postoperative pericardial fluidum
  1/70

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Posterolateral thoracotomy
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Conclusions

• Expanding fields of congenital heart defects for
  right thoracotomy
• No significant difference in morbidity and
  mortality
• Longer procedure time, but same ECC and
  crossclamp time
• Lower intra and postoperative opiate requirement
• Shorter postoperative respiratory time, more
  frequently extubation in OR

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We recommend right thoracotomy a safe and
cosmetically pleasing alternative to median
sternotomy

• We propose to expand the scope of anomalies
  addressed surgically using right thoracotomy
  approach

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Thank you for your attention !
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Have a very good time in Budapest !