Evaluating the efficacy of right vertical infra-axillary thoracotomy vs. standard median sternotomy for atrial septal defect repairs: A single center analysis from Pakistan

Abstract

Objective: To compare early postoperative outcomes of Right Vertical Infra-Axillary Thoracotomy (RVIAT) versus Standard Median Sternotomy (SMS) for atrial septal defect (ASD) and partial atrioventricular septal defect (AVSD) repair.

Methodology: A retrospective study was conducted from June 2024 to July 2025 at the Peshawar Institute of Cardiology. Patients were divided into SMS (n=36) and RVIAT (n=36) groups. Operative times, hematologic parameters, transfusion requirements, ventilation duration, drainage volume, ICU/hospital stay, and complications were analyzed. Multivariate regression was used to adjust for age differences.

Results: The SMS group was significantly older than the RVIAT group (18.39 ± 11.65 vs. 6.80 ± 5.91 years; p<0.001). SMS showed longer cross-clamp time and higher ventilation time, chest drainage, and blood transfusion requirements. After adjusting for age, RVIAT retained lower blood transfusion volume, less chest drainage, and higher preoperative hemoglobin and platelet counts. ICU stay, hospital stay, and major complications were comparable between groups, with only one re-opening and two residual shunts in SMS.

Conclusions: RVIAT is a safe, minimally invasive alternative to sternotomy, offering reduced postoperative morbidity and superior cosmetic outcomes. This is particularly advantageous for pediatric and young adult patients.