Minimally invasive vertical right axillary thoracotomy offers an excellent cosmetic and functional alternative to standard median sternotomy for congenital heart repairs in children. We report the steps taken and challenges involved in building an emerging programmes and outcomes in repairing diverse CHDs.

We performed a retrospective review of the first 152 paediatric patients who underwent repair of selected CHDs using the minimal invasive vertical right axillary thoracotomy approach between April 2022 and December 2025 at our institution and outline our multi-disciplinary team-building protocol.

Pre-commencement protocolar team teaching was implicated 2 months prior to the first case, using information gained through a combination of surgical site visits abroad by the surgeons, protocolar experience exchange with foreign experts, and multimedia educational platforms. The median age was 4.9 years (range: 4 months–13 years), and median weight was 16 kg (6–41 kg). The median lengths of ICU stay and hospital stay were 1.2 and 4.6 days, respectively. No in-hospital deaths or conversions to median sternotomy occurred. No late deaths or reoperations occurred during a median follow-up of 16 months (range 5 months–4 years).

The minimal invasive vertical right axillary thoracotomy can be safely introduced for a broad spectrum of CHDs. Educating all team members is critical to achieving excellent outcomes in a short-time frame. This approach provides excellent cosmetic results with a small “hidden” scar and stands as a good alternative to median sternotomy in selected paediatric patients.

Given the high prevalence of mental health challenges, the field of paediatric cardiology has increasingly recognised the need for integrated and embedded psychosocial programming in cardiology care. In response to this, the University of Michigan Congenital Heart Centre Psychosocial and Educational (M-COPE) Program was established in January 2020. This paper aims to describe the development, current structure, preliminary outcomes, and future directions of the M-COPE Program to inform similar programme development efforts.

Informed by a comprehensive needs assessment (group/individual interviews, patient surveys), the M-COPE Program mission centres on expanding (1) psychosocial clinical services, (2) psychosocial research, (3) mental health training for all learners, and (4) advocacy for improved psychosocial care for paediatric cardiology patients and families.

In its first five years, the M-COPE Program has expanded access to mental health care by increasing the number of psychosocial clinicians, embedding psychology/perinatal psychiatry in select cardiology clinics, and developing novel modes of service delivery through collaborative efforts across our multidisciplinary teams. Training initiatives have included the development of cardiac psychology fellowships and a mental health curriculum for cardiology physician fellows. Research is foundational to the programme, ranging from federally funded research to centre-specific quality improvement projects.

The M-COPE Program has become foundational to our heart centre. Future directions include enhancing psychosocial care at home for patients/caregivers, integration of a perinatal psychiatrist, and wider-scale launch of novel patient-focused initiatives. Continued study of programme impact will be ongoing with key metrics including referral patterns and patient/family outcomes.