Thoracotomy Repair

A thoracotomy is a type of minimally invasive cardiac surgery that can be used to treat congenital heart defects (CHDs) such as atrial septal defects (ASD), ventricular septal defects (VSD), and some types of vascular rings. Because it involves a smaller, less obvious incision, a thoracotomy can result in less post-operative discomfort, as well as a faster recovery, compared to open-heart surgery.

Boston Children’s is one of the few pediatric hospitals to offer a thoracotomy in children and adults to treat a range of CHDs.

Children and adults whose CHDs can be surgically repaired without the need for an incision through the sternum (breastbone) may be eligible for a thoracotomy. The types of CHDs we can treat with a thoracotomy include:

• Atrial septal defect
• Vascular rings such as right aortic arch with aberrant left subclavian or double aortic arch
• Ventricular septal defect
• Complete AV canal defect
• Tetralogy of Fallot (for some patients)
• Patent ductus arteriosus (PDA)

Our team will review treatment options with your family and answer any questions to help you make the best decision about minimally invasive cardiac surgery.

While your child is under anesthesia, our surgeons will access their heart with a small incision in one of two areas underneath the armpit. The small size and location of the incision help lessen discomfort after the operation.

• An axillary thoracotomy incision runs vertically underneath the armpit, usually in a space between the ribs. It is the most common type of thoracotomy our team performs.
• A posterolateral thoracotomy incision is made curving downward, from the back to the ribs and underneath the armpit.

A thoracotomy has several benefits, particularly when compared with a sternotomy, a type of open-heart surgery which makes an incision to the sternum.

• After a thoracotomy, your child will not need wires placed in the sternum to support healing.
• A thoracotomy doesn’t require the removal of the thymus.
• The incision scar is less visible.
• Overall, recovery is shorter.

Our goal is to get your child moving not long after surgery so that they can recover and leave the hospital as soon as possible. Our colleagues from the Enhanced Recovery After Cardiac Surgery (or ERAS Cardiac) Program, who use evidence-based techniques that lessen pain and lower complications, may also be part of your child’s recovery team.

Thoracotomy patients typically go home within two to three days. The first few weeks your child is home, they will need to rest, limit activity, and avoid injury to the surgical area. If recovery goes as planned, your child could be able to resume contact sports and other physical activities four to six weeks after the procedure.