Lung-Protective Effect of Alveolar Recruitment Maneuvers in Children with Right Vertical Infra-Axillary Thoracotomy for Repair of Congenital Heart Disease

Background/Objectives: Right vertical infra-axillary thoracotomy to repair ventricular septal defects (VSDs) and atrial septal defects (ASDs) is less invasive than conventional surgical repair via median sternotomy. However, right vertical infra-axillary thoracotomy (RVIAT) may result in unilateral lung injury, a serious postoperative complication requiring extracorporeal circulation and unilateral lung collapse. The aim of this study was to evaluate whether repeated lung recruitment provides enhanced respiratory compliance and lung oxygenation in children who have undergone right vertical infra-axillary thoracotomy (RVIAT) to correct a congenital heart defect. Methods: Eligible participants were children with a common congenital heart defect corrected via RVIAT. Seventy-seven children were randomly classified into two groups. In group A (n = 39), an alveolar recruitment maneuver (ARM) was performed immediately after cardiopulmonary bypass. Children in group C (n = 38) did not receive any additional interventions during surgery. Results: The ARM group tolerated open lung ventilation without significant hemodynamic instability. Compared to controls, intraoperative PaO2, PaO2/FiO2 and lung compliance (Comdyn) improved in group A (p < 0.05), who also showed a significantly lower IL-6 (p < 0.05). In addition, group A had a lower incidence of lung injury and lung atelectasis than Group C at specific post CPB time points. Conclusions: Our findings provide some indication that the application of ARM could effectively improve the oxygenation profile, reduce postoperative pulmonary complications, and attenuate the postoperative inflammatory response in children with a common congenital heart defect corrected via the RVIAT technique.