title: Minimally invasive pediatric cardiac surgery. Atrial septal defect closure through axillary and submammary approaches.
abstract: OBJECTIVE
  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.
authors.affiliation: Cirugía Cardiaca, Hospital Materno-Infantil Carlos Haya, Málaga, España.
authors.forename: Juan Miguel
authors.initials: JM
authors.lastname: Gil-Jaurena
authors.forename: Juan-Ignacio
authors.initials: JI
authors.lastname: Zabala
authors.forename: Lourdes
authors.initials: L
authors.lastname: Conejo
authors.forename: Victorio
authors.initials: V
authors.lastname: Cuenca
authors.forename: Beatriz
authors.initials: B
authors.lastname: Picazo
authors.forename: Clara
authors.initials: C
authors.lastname: Jiménez
authors.forename: Rafael
authors.initials: R
authors.lastname: Castillo
authors.forename: Manuel
authors.initials: M
authors.lastname: Ferreiros
authors.forename: Manuel
authors.initials: M
authors.lastname: de Mora
authors.forename: Julio
authors.initials: J
authors.lastname: Gutiérrez de Loma
mesh_terms: D000293:Adolescent; D001365:Axilla; D001940:Breast; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000601:surgery*; D006801:Humans; D019060:Minimally Invasive Surgical Procedures / Q000379:methods