Open Access

ARTICLE

Expert Consensus on Right Axillary Incision Approach for Open-Heart Surgery in Congenital Heart Disease

Xuming Mo^1,*, Taibing Fan^2,*, Zhongdong Hua^3,*, Christoph Haller⁴, Shinichiro Oda⁵, Shuhua Luo⁶, Weijie Liang², Yuzhong Yang¹, Huaipu Liu³, Nianguo Dong⁷, Shoujun Li⁸, Xinxin Chen⁹, Jimei Chen¹⁰, Hao Zhang¹¹, Qiang Shu¹², Haibo Zhang¹¹, Quansheng Xing¹³, Jinghao Zheng¹¹, Xiaofeng Li¹⁴, Teng Ming¹⁵, Qi An¹⁶, Ping Wen¹⁷, Qiang Wang¹⁸, Jirong Qi¹, Huiwen Chen¹¹, Shusheng Wen¹⁹, Rui Chen²⁰, Ming Ye²¹, Keming Yang⁸, Minhua Fang²², Caixia Liu²³, Ke Lin¹⁶, Zhongshi Wu²⁴, Xiangming Fan¹², Zhengxia Pan²⁵, Yiqun Ding²⁶, Ming’an Pi²⁷, Xin Li²⁸, Yong Zou²⁹, Shuguang Tao³⁰, Renwei Chen³¹, Li Ma⁹, Libing Zhang³², Tao You³³, Dongshan Liao³⁴, Cheng Zhou³⁵, Hongxin Li³⁶, Gengxu Zhou³⁷, Chunhu Gu³⁸, Zhiqiang Li³⁹, Yonggang Li²⁵, Hui Zhang⁴⁰, Xiaomin He¹¹, Yanan Lu¹¹, Haifa Hong⁴¹, Benqing Zhang⁸, Li Gong²⁷, Jiafeng Qi⁴², Song Bai³⁹, Yuhang Liu⁴³, Tianli Zhao²⁴, Cardiothoracic Surgery Group, Pediatric Surgery Branch of Chinese Medical Doctor Association, Cardiac Surgery Group, Pediatric Surgery Branch of Chinese Medical Association, the Asian Association for Pediatric and Congenital Heart Surgery

1 Department of Cardiothoracic Surgery, Children’s Hospital of Nanjing Medical University, Nanjing, China
2 Department of Cardiovascular Surgery, Fuwai Central China Cardiovascular Hospital, Zhengzhou, China
3 Department of Cardiothoracic Surgery, Shenzhen Children’s Hospital, Shenzhen, China
4 Department of Cardiovascular Surgery, Sick Children Hospital Toronto Canada, Toronto, ON, Canada
5 Division of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
6 Department of Cardiovascular Surgery, West China Second Hospital of Sichuan University, Chengdu, China
7 Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
8 Pediatric Cardiac Surgery Center, Fuwai Hospital, National Centre for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
9 Cardiovascular Center, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
10 Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
11 Department of Cardiothoracic Surgery, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
12 Department of Cardiac Surgery, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
13 Heart Center, Qingdao Women and Children’s Hospital, Qingdao, China
14 Department of Cardiac Surgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
15 Pediatric Heart Disease Treatment Center of Jiangxi Province, Jiangxi Provincial Children’s Hospital, Nanchang, China
16 Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China
17 Heart Center, Dalian Municipal Women and Children’s Medical Center (Group), Dalian, China
18 Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
19 Department of Cardiovascular Surgery, Guangdong Provincial People’s Hospital, Guangzhou, China
20 Department of Cardiovascular Surgery, Women and Children’s Hospital of Qingdao University, Qingdao, China
21 Department of Cardiothoracic Surgery, Children’s Hospital of Fudan University, Shanghai, China
22 Department of Cardiothoracic Surgery, General Hospital of Northern Theater Command, Shenyang, China
23 Department of Cardiology, Children’s Hospital of Shanxi, Women Health Center of Shanxi, Taiyuan, China
24 Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
25 Department of Cardiothoracic Surgery, Children’s Hospital of Chongqing Medical University, Chongqing, China
26 Department of Pediatric Cardiology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
27 Department of Cardiothoracic Surgery, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
28 Department of Cardiothoracic Surgery, Children’s Hospital of Soochow University, Suzhou, China
29 Pediatric Heart Disease Treatment Center of Jiangxi Province, Jiangxi Provincial Children’s Hospital, Nanchang, China
30 Department of Cardiac Surgery, Children’s Hospital in Hebei Province, Shijiazhuang, China
31 Department of Cardiothoracic Surgery, Hainan Women and Children’s Medical Center, Haikou, China
32 Department of Pediatric Surgery, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
33 Department of Cardiothoracic Surgery, Gansu Provincial Hospital, Lanzhou, China
34 Department of Cardiothoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China
35 Department of Cardiothoracic Surgery, Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
36 Department of Cardiothoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
37 Department of Cardiothoracic Surgery, The 7th Medical Center of Chinese PLA General Hospital, Beijing, China
38 Department of Cardiothoracic Surgery, Xijing Hospital, Xi’an, China
39 Department of Cardiothoracic Surgery, Beijing Children’s Hospital, Capital Medical University, Beijing, China
40 Department of Cardiothoracic Surgery, Children’s Hospital Affiliated to Capital Institute of Pediatrics, Beijing, China
41 Department of Cardiothoracic Surgery, Shanghai Children’s Hospital, Shanghai Jiao Tong University, Shanghai, China
42 Department of Cardiothoracic Surgery, Harbin Children’s Hospital, Harbin Medical University, Harbin, China
43 Department of Cardiothoracic Surgery, Dalian municipal Women and Children’s Medical Center, Dalian, China

* Corresponding Authors: Xuming Mo. Email: ; Taibing Fan. Email: ; Zhongdong Hua. Email:

Structural and Congenital Heart Disease 2026, 21(1), 2 https://doi.org/10.32604/schd.2026.077974

Received 21 December 2025; Accepted 28 February 2026; Issue published 31 March 2026

Abstract

Congenital heart disease (CHD) is a common birth defect in children, and surgical intervention is the primary treatment. The traditional standard median sternotomy (MS) has drawbacks such as significant trauma and obvious scarring. The right axillary incision (RAI) has gradually become a conventional approach due to its advantages of preserving thoracic cage integrity, small incision size, rapid recovery, and hidden scarring. However, there is currently a lack of relevant guidelines and consensus for its application. This consensus adopts the international Delphi process, systematically searching domestic and foreign literature on CHD from 1982 to 2024. It uses the GRADE system for evidence grading and, through multidisciplinary expert discussions, clarifies the applicable CHD types, surgical techniques, establishment of extracorporeal circulation, organ protection strategies, management of special disease types, and approaches to common complications of RAI. Results show that RAI is strongly recommended for most simple congenital heart diseases (CHDs) (e.g., simple ventricular septal defect, atrial septal defect), weakly recommended for some complex CHDs (e.g., mild tetralogy of Fallot), and not recommended for complex CHDs such as transposition of the great arteries or in children with severe right thoracic deformity. Additionally, it standardizes key operational parameters: weight (5–30 kg as optimal), age (6 months–6 years as preferred), incision location, extracorporeal circulation cannulation, and organ protection measures. This consensus provides an evidence-based basis for standardizing the clinical application of RAI in open-heart surgery for CHD, ensuring surgical safety and efficacy.

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