Vertical right axillary thoracotomy: strategic insights for reproducible outcomes

Vertical right axillary thoracotomy (VRAT) has become a useful minimally invasive technique for treating certain congenital and acquired heart conditions. By making a vertical cut along the right axillary line, VRAT provides excellent access to the heart while reducing chest wall trauma and improving cosmetic results. It has been effectively used for repairing atrial septal defects, partial anomalous pulmonary venous return, tricuspid valve issues, and some aortic and left-sided lesions in suitable patients. Although these benefits are clear, broader adoption is constrained by concerns about limited visibility and unfamiliar surgical angles. Nevertheless, growing experience shows that, with careful patient selection, proper planning, and adherence to standardized procedures, VRAT can be performed safely and achieve outcomes comparable to those of traditional sternotomy. It also reduces post-operative pain, shortens recovery time, and improves patient satisfaction. As demand for less invasive cardiac surgeries increases, VRAT stands out as a valuable and adaptable surgical option in modern minimally invasive practice.