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Revolutionary Surgery - Armpit Incision with Almost Invisible Scar

Summary of “The Right Axillary Incision: A Potential New Standard of Care for Selected Congenital Heart Surgery”

  • A revolutionary surgery technique – repairing infants’ and children’s heart defects through an armpit incision instead of the chest – is safe, effective and leaves an almost invisible scar while enabling patients to recover, and go home after surgery, more quickly.
  • This axillary-incision procedure was pioneered by Khanh H. Nguyen, MD, Chief of Pediatric Cardiac Surgery at Maria Fareri Children’s Hospital, a member of the Westchester Medical Center Health Network (WMCHealth).
  • This procedure avoids children having a surgery incision (and later, a sizeable scar) down the center of the chest. Such an incision is part of traditional open-heart surgery.
  • Because the procedure is done under the arm, not through the chest, the breast bone and chest muscle are not affected, which helps speed recovery.
  • The result: Patients go home and return to normal activities faster.

This study, published in Seminars in Thoracic and Cardiovascular Surgery, details how a revolutionary surgery technique – repairing infants’ and children’s heart defects through an armpit incision instead of the chest – is safe, effective, durable and leaves an almost invisible scar while speeding recovery.

The right-axillary incision, “a potential new standard of care for many patients,” was pioneered by Khanh H. Nguyen, MD, Chief of Pediatric Cardiac Surgery at Maria Fareri Children’s Hospital, a member of the Westchester Medical Center Health Network (WMCHealth). For appointments or referrals, please call 914.493.8793.

Dr. Nguyen’s compassionate, patient-first approach led him to this groundbreaking method. It spares children from an incision (and later, a sizeable scar) down the center of the chest, called a median sternotomy, a common precursor to traditional open-heart surgery. Instead, a small horizontal incision in the armpit avoids the surgical necessity, when operating through the chest, of splitting of breast bone. The actual cardiac procedures are carried out in the same manner as those experiencing the median sternotomy.

The axillary incision has played a major role in the treatment of pediatric patients at Maria Fareri Children’s Hospital. While avoiding the lifelong negative psychological effect of having a visible chest scar, it also has enabled the patient to resume athletic activity, especially contact sports, much sooner because there are no broken bones to heal and the incision is muscle-sparing. The avoidance of cutting the breast bone reduces blood loss and post-operative chest-tube drainage. This approach, combined with a regimen of pain-control medication, has led to very short stays in the Intensive Care Unit. In fact, a majority of patients undergoing this incision to close an atrial septal defect (a hole in the wall between the heart’s two uppermost chambers, the right and left atrium) has been discharged to return home the next day.

At the time the Seminars in Thoracic and Cardiovascular Surgery study was written, the right transverse axillary incision had been performed on 358 patients who underwent 24 distinct cardiac procedures between 2005 and 2016. The study concluded that the incision “is a valuable surgical approach for a wide variety of congenital cardiac surgeries that allows for excellent results and an unsurpassed cosmetic outcome.” As an update, Dr. Nguyen and his team have now operated on more than 500 patients using the axillary incision for a wide range of conditions. This includes the team’s recent performance of a Glenn procedure, a complex bypass operation to correct suboptimal function of the heart’s right pumping chamber.

Seminars in Thoracic and Cardiovascular Surgery is the official journal of the American Association for Thoracic Surgery. The publication provides cardiothoracic surgeons with cutting-edge information and insights. This study was published in February 2018.

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