Preferred age for beating-heart atrial septal defect repair via right subaxillary mini-incision in pediatric patients

OBJECTIVE: We aimed to evaluate the outcomes of beating-heart atrial septal defect (ASD) repair through a right subaxillary mini-incision in children of different ages and identify the preferred surgical age. METHODS: This retrospective study included 215 children who underwent beating-heart ASD repair via a right subaxillary mini-incision between January 2022 and December 2024. Patients were divided into three age groups: Group 1 (≤ 12 months, n = 47), Group 2 (12–60 months, n = 137), and Group 3 (> 60 months, n = 31). Perioperative variables including cardiopulmonary bypass (CPB) time, operative duration, postoperative ventilator support duration, 24-hour chest drainage, postoperative hospital stay, and postoperative complications were recorded and analyzed. RESULTS: No perioperative deaths occurred, and all patients achieved complete defect closure without intraoperative residual shunting. CPB time, hospital stay, and overall complicate rates showed no significant differences among age groups. However, operative time, ventilator duration, and 24-hour drainage varied significantly. Patients aged 12–60 months (Group 2) demonstrated the most favorable surgical and postoperative outcomes with shorter operations, reduced ventilator use, lower drainage, and a lower incidence of pneumopericardium compared with the other groups. CONCLUSION: Beating-heart ASD repair through a right subaxillary mini-incision is safe and effective for all pediatric age groups. Patients aged 12 to 60 months appear to be the preferred candidates for this minimally invasive approach.