Doubly committed subarterial ventricular septal defect closure through tricuspid approach: a clinical analysis

Background: The research was to introduce the experience of doubly committed subarterial ventricular septal defect (DCVSD) repaired through tricuspid approach. Methods: From January, 2015 to September, 2019, 86 consecutive DCVSD paediatrics underwent repair via right subaxillary vertical incision (RAVI) through tricuspid approach. Perioperative and follow-up data were collected. Results: The age and weight at operation were 28.1 +/- 18.5 (range: 7-101) months and 12.2 +/- 4.2 (6-26.5) kg. There were two patients combined with discrete subaortic membrane, two patients with patent ductus arteriosus, one patient with atrial septal defect, and two patients with abnormal muscle bundle in right ventricular outflow tract. The mean size of ventricular septal defect was 7.0 +/- 2.4 (3-13) mm. The defect was repaired with a piece of Dacron patch in 68 patients or directly with 1-2 pledgetted polypropylene sutures in 18 patients. The cardiopulmonary bypass time and aortic cross-clamp time were 46.2 +/- 13.3 (23-101) minutes and 29.2 +/- 11.5 (12-84) minutes. After 3.1 +/- 2.4 (0-14) hours' ventilator assist and 23.2 +/- 32.1 (0-264) hours' ICU stay, all patients were discharged safely. At the latest follow-up (27.9 +/- 14.6 months), echocardiography showed trivial residual shunt in two patients. There was no malignant arrhythmia occurred and there was no chest deformity or asymmetrical development of the breast was found. Conclusions: DCVSD repaired via right subaxillary vertical incision through tricuspid approach was safe and feasible, providing a feasible alternative to median sternotomy, and it can be performed with favourable cosmetic results.