Short-term Outcomes of Atrial Septal Defect Repair via Right Axillary Incision: A Single-center Propensity-matched Analysis

Background To compare the short-term outcomes of atrial septal defect (ASD) repair via right axillary incision (RAI) versus median sternotomy (MS). Methods This single-center, retrospective, controlled study aimed to compare the short-term outcomes of ASD repair performed via right axillary incision versus median sternotomy. The primary endpoint was the incidence of postoperative residual shunt. Results A total of 210 patients were included in this study, with 67 patients in the RAI group and 143 patients in the MS group. The overall mean age of enrolled patients was 22.4 years, and 72 (34.3%) patients of them were male. The RAI group had less intraoperative bleeding ( P  < 0.001), shorter ventilation time ( P  < 0.001), and shorter drainage time ( P  = 0.004). The overall median follow-up time was 6.0 (3.0–11.0) months. During the last follow-up, residual shunt was observed in one patient in each group [1 (1.5%) vs. 1 (0.7%); P  = 0.544]. During propensity score matching, 20 patients from the RAI group and 23 from the MS group were successfully matched. After match, the RAI group exhibited longer cardiopulmonary bypass time ( P  = 0.027), less drainage time ( P  = 0.013) and less drainage in 24 hours ( P  < 0.001). No patient from either group still had residual shunt during the last follow-up. Weight, age, height, and chest depth were identified as potential predictors in assisting the decision-making between RAI and MS approaches. Conclusion The RAI approach is a safe option for ASD repair with satisfactory outcomes. The RAI approach demonstrates comparable perioperative and short-term surgical outcomes to the conventional MS approach.