Right axillary thoracotomy versus median sternotomy for repair of subarterial ventricular septal defect in adolescents and adults

BACKGROUND: Subarterial ventricular septal defect (sVSD) has a relatively high incidence in the Asian population. Surgical repair remains the preferred treatment. This research aims to report on the application of a modification of the surgical approach in the treatment of sVSD in adolescents and adults; (2) METHODS: This retrospective cohort study included 74 consecutive patients aged 14 years or older with sVSD who underwent surgical repair between January 2016 and December 2024.Patients were divided into Group A (right axillary thoracotomy) and Group B (median sternotomy). Perioperative data and long-term follow-up outcomes were analyzed and compared; (3) Results: Baseline characteristics were comparable between groups. The right axillary thoracotomy group had longer cardiopulmonary bypass and aortic cross-clamp times but significantly lower postoperative drainage volumes. No significant differences were observed in mechanical ventilation time, intensive care unit stay, hospital length of stay, or pre-discharge ventricular function. During long-term follow-up, no deaths, reinterventions, residual shunts, or complete atrioventricular block occurred in either group; (4) Conclusions: In patients aged 14 years or older with sVSD, right axillary thoracotomy achieves perioperative and long-term outcomes comparable to conventional sternotomy, while offering advantages in reduced surgical trauma.