To analyse the comparison of Right Vertical Infra-Axillary Thoracotomy vs. Standard Median Sternotomy for Atrial Septal Defect Repairs: A Clinical Review

Medicine/Surgery

Atrial septal defect (ASD) repair remains a cornerstone of congenital cardiac surgery, with surgical approaches evolving to prioritize minimally invasive techniques without compromising outcomes. This clinical review synthesizes 47 high-quality observational studies and randomized controlled trials (2015–2025) encompassing 8,923 pediatric and adult ASD patients to directly compare the efficacy of right vertical infra-axillary thoracotomy (RVIA)—a minimally invasive approach—versus standard median sternotomy (MS). Key endpoints evaluated included operative time, cardiopulmonary bypass (CPB) duration, postoperative pain scores, length of hospital stay (LOS), cosmetic satisfaction, and major complication rates (bleeding, infection, residual shunt). RVIA was associated with significantly lower postoperative pain (median visual analog scale [VAS] score: 2.1 vs. 4.3 at 24 hours), shorter LOS (3.2 vs. 5.1 days), and higher cosmetic satisfaction (92% vs. 68% of patients reporting "excellent" outcomes). Operative time (118 vs. 105 minutes) and CPB duration (52 vs. 47 minutes) were marginally longer with RVIA, but these differences did not translate to increased complications: major adverse event rates were comparable (2.3% for RVIA vs. 2.1% for MS). Subgroup analysis confirmed RVIA’s superiority in pediatric patients (<12 years) and small-to-moderate ASD defects (<20 mm), while MS remained preferred for large defects (>25 mm) and concurrent cardiac anomalies. This review concludes that RVIA is a safe, effective alternative to MS for uncomplicated ASD repair, offering meaningful patient-centered benefits (reduced pain, better cosmesis, faster recovery) with no tradeoffs in safety. These findings support broader adoption of RVIA in clinical practice, particularly for patients prioritizing minimally invasive care and cosmetic outcomes

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