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Hung LW, Lee CY, Hii HP, Wu NC, Cheng BC. Robot-assisted endoscopic removal of a huge tricuspid valve myxoma: case report. J Cardiothorac Surg 2022; 17:258. [PMID: 36203203 PMCID: PMC9540697 DOI: 10.1186/s13019-022-01978-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 08/26/2022] [Indexed: 11/18/2022] Open
Abstract
Background Cardiac myxoma is the most common benign cardiac tumor. Its tremendous size and fragile character severely bother the surgeons. Several minimal invasive approaches had been applied for radical tumor excision. The wound was forcibly enlarged for en-bloc specimen removal and prevention of debris sputtering. Case presentation We reported a case of huge tricuspid valve (TV) myxoma managed by robot-assisted endoscopic tumor resection and TV repair, with initial presentation of worsening shortness of breath for two months. The tumor was downsized with a morcellator and removed through a keyhole wound (1.1 cm in diameter). The patient recovered uneventfully and was discharged after four days. Conclusions With the first morcellator application, this might be the smallest surgical wound reported after the removal of a huge cardiac myxoma. The ICU and hospital stays were shortened. This might be effectively applied to further minimally invasive surgeries for cardiac tumor excision. Supplementary Information The online version contains supplementary material available at 10.1186/s13019-022-01978-5.
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Affiliation(s)
- Lun-Wu Hung
- Division of Cardiovascular Surgery, Department of Surgery, Chi Mei Medical Center, No. 901, Zhonghua Rd., Yongkang Dist, 710, Tainan City, Taiwan
| | - Cheng-Ya Lee
- Division of Cardiovascular Surgery, Department of Surgery, Chi Mei Medical Center, No. 901, Zhonghua Rd., Yongkang Dist, 710, Tainan City, Taiwan
| | - Hiong-Ping Hii
- Division of Cardiovascular Surgery, Department of Surgery, Chi Mei Medical Center, No. 901, Zhonghua Rd., Yongkang Dist, 710, Tainan City, Taiwan
| | - Nan-Chun Wu
- Division of Cardiovascular Surgery, Department of Surgery, Chi Mei Medical Center, No. 901, Zhonghua Rd., Yongkang Dist, 710, Tainan City, Taiwan
| | - Bor-Chih Cheng
- Division of Cardiovascular Surgery, Department of Surgery, Chi Mei Medical Center, No. 901, Zhonghua Rd., Yongkang Dist, 710, Tainan City, Taiwan. .,Division of Cardiovascular Surgery, Department of Surgery, Tungs' Taichung MetroHarbor Hospital, No.699, Section 8, Taiwan Boulevard, Wuqi District, Taichung City, 43503, Taiwan.
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Toscano A, Barbero C, Capuano P, Costamagna A, Pocar M, Trompeo A, Pasero D, Rinaldi M, Brazzi L. Chronic postsurgical pain and quality of life after right minithoracotomy mitral valve operations. J Card Surg 2022; 37:1585-1590. [PMID: 35274774 DOI: 10.1111/jocs.16400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 02/09/2022] [Accepted: 02/17/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Chronic postsurgical pain (CPSP) is a relatively common complication after cardio-thoracic operations with well-known consequences in terms of return to normal activities and quality of life. Little is known about the prevalence and severity of CPSP after minimally invasive cardiac surgery. The aim of this study was to measure the rate of CPSP in patients undergoing right minithoracotomy mitral valve (MV) surgery and to compare the effectiveness of different approaches to pain control. METHODS A prospective observational study was conducted between March 2019 and September 2020. All patients undergoing right minithoracotomy MV surgery treated with morphine, continuous serratus anterior plane block (SAPB), or continuous erector spinae plane block (ESPB) were included. The Brief Pain Inventory questionnaire was used to evaluate 6-month CPSP and quality of life. RESULTS A total of 100 patients were enrolled: postoperative pain control was obtained with morphine in 26 cases, with SAPB in 37 cases, and with ESPB in 37 cases. Median intensive care unit and hospital length of stay were 1 day and 6 days, respectively. Pain severity index was lower than 10 in 81 patients, and no differences were recorded between groups (p = .59). No patients reported chronic use of medications for pain management or severe pain interference in daily activities at follow-up. DISCUSSION Right minithoracotomy approach is not burdened by a high incidence of CPSP: pain severity index was lower than 10 in more than 90% of patients. Then, in our experience, chronic pain seems not to be related to the type of perioperative analgesia adopted.
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Affiliation(s)
- Antonio Toscano
- Department of Anesthesia, Critical Care and Emergency, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Cristina Barbero
- Department of Cardiovascular and Thoracic surgery, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Paolo Capuano
- Department of Anesthesia and Intensive Care, IRCCS-ISMETT, UPMC, Palermo, Italy
| | - Andrea Costamagna
- Department of Anesthesia, Critical Care and Emergency, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Marco Pocar
- Department of Cardiovascular and Thoracic surgery, Città della Salute e della Scienza Hospital, Turin, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Anna Trompeo
- Department of Anesthesia, Critical Care and Emergency, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Daniela Pasero
- Department of Medical, Surgical and Experimental Science, University of Sassari, Sassari, Italy
| | - Mauro Rinaldi
- Department of Cardiovascular and Thoracic surgery, Città della Salute e della Scienza Hospital, Turin, Italy.,Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Luca Brazzi
- Department of Anesthesia, Critical Care and Emergency, Città della Salute e della Scienza Hospital, Turin, Italy.,Department of Surgical Sciences, University of Turin, Turin, Italy
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Barbero C, Rinaldi M, Marchetto G, Valentini MC, Cura Stura E, Bosco G, Pocar M, Filippini C, Boffini M, Ricci D. Magnetic Resonance Imaging for Cerebral Micro-embolizations During Minimally Invasive Mitral Valve Surgery. J Cardiovasc Transl Res 2021; 15:828-833. [PMID: 34845626 DOI: 10.1007/s12265-021-10188-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 11/11/2021] [Indexed: 10/19/2022]
Abstract
The role of aortic clamping techniques on the occurrence of neurological complications after right mini-thoracotomy mitral valve surgery is still debated. Brain injuries can occur also as silent cerebral micro-embolizations (SCM), which have been linked to significant deficits in physical and cognitive functions. Aims of this study are to evaluate the overall rate of SCM and to compare endoaortic clamp (EAC) with trans-thoracic clamp (TTC). Patients enrolled underwent a pre-operative, a post-operative, and a follow-up MRI. Forty-three patients were enrolled; EAC was adopted in 21 patients, TTC in 22 patients. Post-operative SCM were reported in 12 cases (27.9%). No differences between the 2 groups were highlighted (23.8% SCM in the EAC group versus 31.8% in the TTC). MRI analysis showed post-operative SCM in nearly 30% of selected patients after right mini-thoracotomy mitral valve surgery. Subgroup analysis on different types of aortic clamping showed comparable results. CLINICAL RELEVANCE: The rate of SCM reported in the present study on patients undergoing minimally invasive MVS and RAP is consistent with data in the literature on patients undergoing cardiac surgery through median sternotomy and antegrade arterial perfusion. Moreover, no differences were reported between EAC and TTC: both the aortic clamping techniques are safe, and the choice of the surgical setting to adopt can be really done according to the patient's characteristics.
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Affiliation(s)
- Cristina Barbero
- Department of Cardiovascular and Thoracic Surgery, Città della Salute e della Scienza, University of Turin, Turin, Italy.
| | - Mauro Rinaldi
- Department of Cardiovascular and Thoracic Surgery, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Giovanni Marchetto
- Department of Cardiovascular and Thoracic Surgery, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Maria Consuelo Valentini
- Department of Neuroradiology, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Erik Cura Stura
- Department of Cardiovascular and Thoracic Surgery, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Giovanni Bosco
- Department of Neurology, Città Della Salute E Della Scienza, University of Turin, Turin, Italy
| | - Marco Pocar
- Department of Cardiovascular and Thoracic Surgery, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Claudia Filippini
- Department of Anesthesia and Critical Care, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Massimo Boffini
- Department of Cardiovascular and Thoracic Surgery, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Davide Ricci
- Cardiac Surgery Unit, IRCCS Policlinic Hospital San Martino, Genova, Italy
- Department of Integrated Surgical and Diagnostic Sciences, University of Genova, Genova, Italy
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Barbero C, Rinaldi M, Pocar M, Cura Stura E, Calia C, Sebastiano V, Marchetto G, Filippini C, Boffini M, Ricci D. Endo-Aortic vs. Trans-Thoracic Clamping in Right Mini-Thoracotomy Mitral Valve Surgery: Outcome on Myocardial Protection. Front Cardiovasc Med 2021; 8:719687. [PMID: 34568461 PMCID: PMC8458726 DOI: 10.3389/fcvm.2021.719687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/13/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Perfusion strategies and aortic clamping techniques for right mini-thoracotomy mitral valve (MV) surgery have evolved over time and remarkable short- and long-term results have been reported. However, some concerns have raised about the adequacy of myocardial protection during the minimally invasive approach, particularly with the endo-aortic clamp (EAC). Aim of this study was to compare the efficacy, in terms of myocardial preservation, of the EAC with the trans-thoracic aortic clamp (TTC) in patients undergoing right mini-thoracotomy MV surgery. Methods: A single center, prospective observational study was performed on patients undergoing right mini-thoracotomy MV surgery with retrograde arterial perfusion and EAC or TTC. A propensity matched analysis was performed to compare the two groups. Primary outcome was the comparison between cardiac troponin T levels measured at different time-points after surgery. Results: Eighty EAC patients were compared with 37 TTC patients. No cases of myocardial infarction or low cardiac-output syndrome were overall reported. No differences were recorded in terms of stroke, peri-operative mortality, and in the release of myocardial markers, lactates levels and need for inotropic support at different time-points after surgery. CK-MB peak levels were significantly lower in the EAC group. Conclusion: Despite concerns arising about the EAC, this prospective study shows equivalence in terms of myocardial preservation of the EAC compared with the TTC in patients undergoing right mini-thoracotomy MV surgery.
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Affiliation(s)
- Cristina Barbero
- Department of Cardiovascular Surgery, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Mauro Rinaldi
- Department of Cardiovascular Surgery, Città della Salute e della Scienza, University of Turin, Turin, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Marco Pocar
- Department of Cardiovascular Surgery, Città della Salute e della Scienza, University of Turin, Turin, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Erik Cura Stura
- Department of Cardiovascular Surgery, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Claudia Calia
- Department of Cardiovascular Surgery, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Viviana Sebastiano
- Department of Cardiovascular Surgery, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Giovanni Marchetto
- Department of Cardiovascular Surgery, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Claudia Filippini
- Department of Anesthesia and Critical Care, University of Turin, Turin, Italy
| | - Massimo Boffini
- Department of Cardiovascular Surgery, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Davide Ricci
- Cardiac Surgery Unit, Scientific Institute for Research, Hospitalization and Healthcare Policlinic Hospital San Martino, Genova, Italy.,Department of Integrated Surgical and Diagnostic Sciences, University of Genova, Genova, Italy
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Barbero C, Pocar M, Marchetto G, Cura Stura E, Calia C, Boffini M, Rinaldi M, Ricci D. Antegrade Perfusion for Mini-Thoracotomy Mitral Valve Surgery in Patients with Atherosclerotic Burden. Heart Lung Circ 2021; 31:415-419. [PMID: 34531142 DOI: 10.1016/j.hlc.2021.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 06/21/2021] [Accepted: 08/12/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The relationship between retrograde arterial perfusion and stroke in patients with peripheral vascular disease has been widely documented. Antegrade arterial perfusion has been favoured as an alternative approach in less invasive mitral valve (MV) operations. We aimed to analyse our experience in patients with peripheral arterial disease undergoing MV surgery through a right mini-thoracotomy adopting antegrade arterial perfusion. METHOD A single-institution retrospective study on prospectively collected data was performed on patients undergoing right mini-thoracotomy MV surgery with antegrade arterial perfusion. Since 2009, indication for the latter was dictated by the severity of atherosclerotic burden. Preoperative screening included computed tomography, angiography, or both for the evaluation of the aorta and ileo-femoral arteries. RESULTS Consecutive patients (n=117) underwent MV surgery through a right mini-thoracotomy with antegrade arterial perfusion, established either by transthoracic central aortic cannulation in 65 (55.6%) cases or by axillary arterial cannulation in 52 (44.4%). Mean logistic EuroSCORE was 11%±2.3%. Twenty-five (25) (21.4%) patients had undergone one or more previous cardiac operations. Operative mortality was 4.3% (n=5). Nonfatal iatrogenic aortic dissection occurred in one case (0.8%). The incidence of stroke was zero. CONCLUSIONS Axillary or central aortic cannulation is a promising alternative route to provide excellent arterial perfusion in right mini-thoracotomy MV surgery, with a very low incidence of stroke and other major perioperative complications in patients with severe aortic or peripheral arterial disease.
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Affiliation(s)
- Cristina Barbero
- Cardiovascular and Thoracic Department, "Città della Salute e della Scienza", University of Turin, Turin, Italy
| | - Marco Pocar
- Cardiovascular and Thoracic Department, "Città della Salute e della Scienza", University of Turin, Turin, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
| | - Giovanni Marchetto
- Cardiovascular and Thoracic Department, "Città della Salute e della Scienza", University of Turin, Turin, Italy
| | - Erik Cura Stura
- Cardiovascular and Thoracic Department, "Città della Salute e della Scienza", University of Turin, Turin, Italy
| | - Claudia Calia
- Cardiovascular and Thoracic Department, "Città della Salute e della Scienza", University of Turin, Turin, Italy
| | - Massimo Boffini
- Cardiovascular and Thoracic Department, "Città della Salute e della Scienza", University of Turin, Turin, Italy
| | - Mauro Rinaldi
- Cardiovascular and Thoracic Department, "Città della Salute e della Scienza", University of Turin, Turin, Italy
| | - Davide Ricci
- Cardiovascular and Thoracic Department, "Città della Salute e della Scienza", University of Turin, Turin, Italy
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Application and effects of an early childhood education machine on analgesia and sedation in children after cardiothoracic surgery. J Cardiothorac Surg 2021; 16:118. [PMID: 33933112 PMCID: PMC8088200 DOI: 10.1186/s13019-021-01490-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 04/06/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To study the effect of an early childhood education machine on sedation and analgesia in children after cardiothoracic surgery. METHODS A prospective randomized controlled study was conducted in a provincial hospital in China. Fifty-two patients (aged from 1 to 5 years) underwent cardiothoracic surgery (including: ventricular septal defect, patent ductus arteriosus, atrial septal defect, pulmonary stenosis, pulmonary sequestration and congenital cystic adenomatoid lung malformation) were divided into the study group (n = 26) and the control group (n = 26). The patients in the study group underwent intervention with an early childhood education machine (uniform type) in addition to routine standard treatment and nursing, while the patients in the control group only received routine standard treatment and nursing. Richmond agitation sedation score (RASS) and face, legs, activity, cry, consolability (FLACC) score of all of the patients were evaluated, and the negative emotions (self-rating anxiety scale (SAS) score and self-rating depression scale (SDS) score) of the parents of the two groups were compared. RESULTS There was no significant difference in the general clinical data between the two groups. The RASS and FLACC scores in the study group were significantly lower than those in the control group, and the SAS and SDS scores of the parents in the study group were significantly lower than those in the control group. CONCLUSION The application of an early childhood education machine for children after cardiothoracic surgery can effectively reduce postoperative agitation, improve sedation and analgesia of the patients, and ease the pessimistic mood of the patients' parents.
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Rodrigues SN, Henriques HR, Henriques MA. Effectiveness of preoperative breathing exercise interventions in patients undergoing cardiac surgery: A systematic review. Rev Port Cardiol 2021; 40:229-244. [PMID: 33707091 DOI: 10.1016/j.repc.2020.08.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 07/20/2020] [Accepted: 08/06/2020] [Indexed: 11/16/2022] Open
Abstract
Postoperative pulmonary complications are a common cause of morbidity and mortality in patients undergoing cardiac surgery, leading to an increase in length of hospital stay and healthcare costs. This systematic literature review aims to determine whether patients undergoing cardiac surgery who undergo preoperative breathing exercise training have better postoperative outcomes such as respiratory parameters, postoperative pulmonary complications, and length of hospital stay. Systematic searches were performed in the CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Clinical Answers, Cochrane Database of Systematic Reviews, MEDLINE and MedicLatina databases. Studies were included if they examined adult patients scheduled for elective cardiac surgery, who underwent a preoperative breathing exercise training aimed at improving breathing parameters, preventing postoperative pulmonary complications, and reducing hospital length of stay. This systematic review was based on Cochrane and Prisma statement recommendations in the design, literature search, analysis, and reporting of the review. The search yielded 608 records. Eleven studies met the inclusion criteria. Ten studies were randomized controlled trials and one was an observational cohort study. Data from 1240 participants was retrieved from these studies and meta-analysis was performed whenever possible. A preoperative breathing intervention on patients undergoing cardiac surgery may help improve respiratory performance after surgery, reduce postoperative pulmonary complications and hospital length of stay. However, more trials are needed to support and strengthen the evidence.
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Affiliation(s)
- Soraia Nicola Rodrigues
- Lisbon University, Lisbon, Portugal; Lisbon Nursing School, Lisbon, Portugal; Centro Hospitalar de Vila Nova de Gaia/Espinho, Oporto, Portugal.
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Rodrigues SN, Henriques HR, Henriques MA. Effectiveness of preoperative breathing exercise interventions in patients undergoing cardiac surgery: A systematic review. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2021. [DOI: 10.1016/j.repce.2020.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Barbero C, Marchetto G, Pace Napoleone C, Calia C, Cura Stura E, Pocar M, Rinaldi M, Boffini M. Right mini-thoracotomy approach for grown-up congenital heart disease. J Card Surg 2021; 36:1917-1921. [PMID: 33634523 DOI: 10.1111/jocs.15449] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/05/2021] [Accepted: 02/11/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Right mini-thoracotomy cardiac surgery has been recognized as a safe and effective procedure, with remarkable early and long-terms outcomes. However, most of the literature is focused on mitral valve surgery and few studies report on the minimally invasive approach applied to congenital disease. Aim of this study was to review our experience on patients with grown-up congenital heart (GUCH) undergoing right mini-thoracotomy cardiac surgery. METHODS Data of patients with GUCH undergoing right mini-thoracotomy cardiac surgery from 2006 to 2019 were retrospectively analyzed. Inclusion criteria were atrial septal defect, partial anomalous pulmonary venous return, partial atrioventricular septal defect, and mitral or tricuspid valve dysfunction in congenital heart diseases. RESULTS During the study period 127 patients with GUCH underwent right mini-thoracotomy cardiac surgery. Mean age was 43.6 years and more than 60% were females; diagnosis was atrial septal defect in 57 cases (44.9%); 24 patients were redo (18.9%). No cases of stroke and major vascular complications were reported. Conversion to sternotomy was required in one case (0.8%). No residual shunts or valves dysfunction were recorded at the postoperative echocardiographic evaluation. Perioperative mortality was 1.6%. CONCLUSIONS Right mini-thoracotomy cardiac surgery in selected patients with GUCH allows to avoid the big scar of the sternotomy approach and to accelerate the recovery in a young population. Moreover, in redo cases, it allows the surgeon to reach the heart and the aorta avoiding the well-known risks of a re-sternotomy procedure.
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Affiliation(s)
- Cristina Barbero
- Department of Cardiovascular and Thoracic Surgery, Città della Salute e della Scienza, University of Turin, Torino, Italy
| | - Giovanni Marchetto
- Department of Cardiovascular and Thoracic Surgery, Città della Salute e della Scienza, University of Turin, Torino, Italy
| | - Carlo Pace Napoleone
- Pediatric Cardiac Surgery Division, Department of Pediatrics, Children's Regina Margherita Hospital, Torino, Italy
| | - Claudia Calia
- Department of Cardiovascular and Thoracic Surgery, Città della Salute e della Scienza, University of Turin, Torino, Italy
| | - Erik Cura Stura
- Department of Cardiovascular and Thoracic Surgery, Città della Salute e della Scienza, University of Turin, Torino, Italy
| | - Marco Pocar
- Department of Cardiovascular and Thoracic Surgery, Città della Salute e della Scienza, University of Turin, Torino, Italy
| | - Mauro Rinaldi
- Department of Cardiovascular and Thoracic Surgery, Città della Salute e della Scienza, University of Turin, Torino, Italy
| | - Massimo Boffini
- Department of Cardiovascular and Thoracic Surgery, Città della Salute e della Scienza, University of Turin, Torino, Italy
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He BC, Ke YJ, Zhou K, Chen ZR, Yang J, Li XH, Liu GQ, Guo HM, Chen JM, Zhuang J, Huang HL. Modified unicaval drainage in reoperative isolated tricuspid valve repair via totally thoracoscopic approach. Perfusion 2020; 35:649-657. [PMID: 32403987 DOI: 10.1177/0267659120915659] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Aim: The aim of this study was to investigate the feasibility, safety, and clinical effect of modified unicaval drainage for thoracoscopic reoperative isolated tricuspid valve repair, compared with conventional bicaval drainage. Methods: A total of 45 consecutive cases of patients who underwent thoracoscopic reoperative isolated tricuspid valve repair on beating-heart were enrolled and divided into two groups according to the different venous drainage (Group A: modified unicaval drainage, Group B: conventional bicaval drainage). A retrospective analysis of perioperative data and clinical outcomes were performed and all the surviving cases were followed up. Re-evaluation of echocardiography and electrocardiogram was performed prior to discharge, and at first month, sixth month, and every year follow-up. Results: The overall postoperative 30-day mortality was 4.5% in Group A and 8.7% in Group B. The postoperative tricuspid valve regurgitation grade of both groups decreased significantly from preoperative regurgitation grade, p < 0.001, without intergroup significant difference, p = 0.815. Follow-up duration ranged from 6 to 38 months, there was one death at 24 months in Group A, and another at 9 months in Group B, respectively. Nobody from both groups experienced reintervention for residual tricuspid regurgitation. No significant difference could be identified about the incidence of postoperative morbidities and follow-up adverse events. Conclusion: Both strategies of caval venous drainage can provide satisfactory exposure for thoracoscopic reoperative isolated tricuspid valve repair and equivalent favorable postoperative outcome. And the modified unicaval drainage group may even preserve the anesthetic time and decrease the risk of iatrogenic jugular injury, achieving a more simplified procedure with better cosmetic outcome.
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Affiliation(s)
- Biao-Chuan He
- Department of Cardiovascular Surgery, Guangdong Provincial People’s Hospital, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Academy of Medical Sciences, Guangzhou, P.R. China
| | - Ying-Jie Ke
- Department of Cardiovascular Surgery, Guangdong Provincial People’s Hospital’s Nanhai Hospital, The Second People’s Hospital of Nanhai District, Foshan, P.R. China
| | - Kan Zhou
- Department of Cardiovascular Surgery, Guangdong Provincial People’s Hospital, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Academy of Medical Sciences, Guangzhou, P.R. China
| | - Ze-Rui Chen
- Department of Cardiovascular Surgery, Guangdong Provincial People’s Hospital, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Academy of Medical Sciences, Guangzhou, P.R. China
| | - Jue Yang
- Department of Cardiovascular Surgery, Guangdong Provincial People’s Hospital, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Academy of Medical Sciences, Guangzhou, P.R. China
| | - Xiao-Hong Li
- Department of Cardiovascular Surgery, Guangdong Provincial People’s Hospital, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Academy of Medical Sciences, Guangzhou, P.R. China
| | - Gui-Qing Liu
- Cardiothoracic Surgery, Hammersmith Hospital, London, UK
| | - Hui-Ming Guo
- Department of Cardiovascular Surgery, Guangdong Provincial People’s Hospital, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Academy of Medical Sciences, Guangzhou, P.R. China
| | - Ji-Mei Chen
- Department of Cardiovascular Surgery, Guangdong Provincial People’s Hospital, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Academy of Medical Sciences, Guangzhou, P.R. China
| | - Jian Zhuang
- Department of Cardiovascular Surgery, Guangdong Provincial People’s Hospital, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Academy of Medical Sciences, Guangzhou, P.R. China
| | - Huan-Lei Huang
- Department of Cardiovascular Surgery, Guangdong Provincial People’s Hospital, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Academy of Medical Sciences, Guangzhou, P.R. China
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Abdelbar A, Niranjan G, Tynnson C, Saravanan P, Knowles A, Laskawski G, Zacharias J. Endoscopic Tricuspid Valve Surgery is a Safe and Effective Option. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2020; 15:66-73. [PMID: 31903869 DOI: 10.1177/1556984519887946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Isolated tricuspid surgery through median sternotomy can be associated with a high morbidity and mortality. Reports of minimally invasive isolated tricuspid valve operations are rare, but the outcomes are encouraging. We present our experience of endoscopic isolated tricuspid valve surgery. METHODS In our institution, 452 patients underwent endoscopic minimal access cardiac surgery between August 2008 and December 2018. A total of 90 patients underwent tricuspid valve surgery whether isolated or with other cardiac procedure. We further selected patients who had isolated tricuspid valve surgery (n = 24). Of these patients, 13 (54%) had more than one previous sternotomy. RESULTS Tricuspid repair was performed in 18 patients (75%) with the remaining 6 (25%) having bioprosthetic tricuspid replacement. Three (12.5%) were performed with a beating heart, the remaining with endoaortic clamping and cardioplegia. There were no conversions to sternotomy. None of the patients had reoperation for bleeding, tamponade, or valve issues. Three patients (12.5%) required blood transfusion, 3 patients (12.5%) required renal dialysis, and 7 patients (29%) had respiratory complications such as chest infection, requiring continuous positive airway pressure (CPAP) with 2 being re-intubated. One patient (4.1%) died within 30 days from chest sepsis leading to multi-organ failure. Mean hospital stay was 11.1 ± 8.9 days (median of 8). All patients had mild or less regurgitation on follow-up echo at 6 months. CONCLUSIONS Isolated tricuspid valve surgery can be performed through an endoscopic minimally access approach, with good results. It appears to provide better results than a sternotomy approach. A high repair rate can be achieved, and the procedure is particularly valuable in redo-surgery with low mortality and morbidity compared to historical sternotomy case series.
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Affiliation(s)
- Abdelrahman Abdelbar
- 171993 Department of Cardiothoracic Surgery, Lancashire Heart Centre, Blackpool Victoria Hospital, Manchester, UK
| | - Gunaratnam Niranjan
- 171993 Department of Cardiothoracic Surgery, Lancashire Heart Centre, Blackpool Victoria Hospital, Manchester, UK
| | - Charlene Tynnson
- 171993 Department of Cardiothoracic Surgery, Lancashire Heart Centre, Blackpool Victoria Hospital, Manchester, UK
| | - Palanikumar Saravanan
- 171993 Department of Cardiothoracic Anaesthesia, Lancashire Heart Centre, Blackpool Victoria Hospital, Manchester, UK
| | - Andrew Knowles
- 171993 Department of Cardiothoracic Anaesthesia, Lancashire Heart Centre, Blackpool Victoria Hospital, Manchester, UK
| | - Grzegorz Laskawski
- 171993 Department of Cardiothoracic Surgery, Lancashire Heart Centre, Blackpool Victoria Hospital, Manchester, UK.,171993 Department of Cardiovascular Surgery, Medical University of Gdansk, Poland
| | - Joseph Zacharias
- 171993 Department of Cardiothoracic Surgery, Lancashire Heart Centre, Blackpool Victoria Hospital, Manchester, UK
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