Optimal Age for Beating-Heart Atrial Septal Defect Repair via Right Subaxillary Mini-Incision in Pediatric Patients

Objective To evaluate the clinical outcomes of atrial septal defect (ASD) repair on the beating heart through right subaxillary mini-incision in pediatric patients of different age groups, and to determine the optimal surgical age. Methods A retrospective study was conducted on 215 children with ASD who underwent beating-heart repair through a right subaxillary mini-incision between January 2022 and December 2024. Patients were divided into three age groups: Group 1 (≤ 12 months, n  = 47), Group 2 (12–60 months, n  = 137), and Group 3 (> 60 months, n  = 31). Main perioperative metrics such as cardiopulmonary bypass (CPB) time, operative duration, postoperative ventilator support duration, 24-hour chest drainage, and postoperative hospital stay were recorded and analyzed. Results No perioperative deaths occurred and all patients achieved complete defect closure without residual shunting. While CPB duration, postoperative complications, and hospital stay showed no significant intergroup differences, operative time, ventilator duration, and 24-hour drainage volume varied significantly by age. Patients aged 12–60 months (Group 2) demonstrated the most favorable surgical and postoperative outcomes, with the shortest operative time and ventilator use, and lower drainage compared to other groups. Conclusion Beating-heart ASD repair via right subaxillary mini-incision is safe and effective across pediatric age groups. Children aged 12 to 60 months may represent the optimal candidates for this minimally invasive approach.