Modified Right Vertical Infra-Axillary Thoracotomy for Ventricular Septal Defect Repair Across Age Groups: A Single-Center Cohort Study.

BACKGROUND: To describe the feasibility, perioperative outcomes, and short-term follow-up of ventricular septal defect (VSD) repair using a modified right vertical infra-axillary thoracotomy (MRVIAT) across a broad age and weight range. METHODS: This retrospective study included 1,212 patients with ventricular septal defect who underwent surgical repair via a MRVIAT at our institution between January 2022 and December 2024.All procedures were performed through a single 2-5 cm incision under central cardiopulmonary bypass. RESULTS: All procedures were completed successfully, with no in-hospital mortality and no conversion to median sternotomy. The median age was 0.6 years (range, 18 days to 45 years), including 16 neonates aged <28 days (1.3%) and 36 adults (3.0%). The median body weight was 7.0 kg (range, 1.8-105 kg), including 16 patients weighing ≤3 kg (1.3%). The median operative time was 100.0 minutes (IQR, 95.0-110.0), with a median cardiopulmonary bypass time of 46.0 minutes (IQR, 40.0-52.0) and a median aortic cross-clamp time of 27.0 minutes (IQR, 23.0-33.0). The median postoperative hospital stay was 6.0 days (IQR, 6.0-8.0). During a median follow-up of 1.3 years (IQR, 0.3-2.5 years), no thoracic deformity, moderate or severe valvular regurgitation, or surgery-related reintervention was observed. CONCLUSIONS: In this single-center retrospective cohort, VSD repair via MRVIAT was feasible in selected patients across a broad age and weight range and was associated with favorable short-term outcomes. Comparative studies are required to determine whether this approach offers advantages over median sternotomy.