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23 t m c » p u l s e | o c t o b e r 2 0 1 8 our shoulders and back, and we don't cut them, either," Dodge-Khatami said. "We spread them apart so we are able to enter the chest in an area where we are not actually cutting muscle. That helps the kids recover more quickly and they can move their shoulders and they can move their back muscles." The minimally-invasive surgery takes a little bit longer to perform than an open-heart procedure to repair a VSD, but Dodge-Khatami said it reduces the recovery time for patients and leaves a far less visible scar. "Ultimately, the one or two days less in the hospital, or the 30 or 40 minutes extra that it takes to do the operation, in the lifetime of a kid, probably doesn't mean much," Dodge-Khatami said. "But what it means to them 10 or 15 years from now is where I would anticipate the huge benefit to be. They won't think of themselves as heart patients." Dodge-Khatami began doing this procedure in the early 2000s and has performed it hundreds of times. "When I started this with my boss in Zurich, I thought it was crazy … because it is technically more challenging," he said. "It takes more time to do in the beginning when you are learning. You have to be more careful with certain things because there is not a lot of margin of error. In time, when you get comfortable with it, you eliminate that risk and it shouldn't be any riskier than what we do up front. I think that is part of the reason it is not as widespread as it could be." Although the procedure is uncom- mon now, a right axillary thoracotomy was a method of entry for cardiology pioneers 70 years ago. "The right thoracotomy approach, historically, if you go back, is one of the initial approaches surgeons used in the '40s and '50s," Dodge-Khatami explained. "At a time when we still didn't have the heart-lung machine, some of the more primitive repairs—closed valve repairs—were done through this approach." (continued) Ethan winds up for a pitch during baseball practice at The Zone in Kingwood, Texas.