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Sakamoto SI, Amitani R, Motoji Y, Yamaguchi T, Hiromoto A, Suzuki K, Ishii Y. Combined cardiac surgery in a Marfan syndrome patient with severe scoliosis via lower hemisternotomy: a case report. Surg Case Rep 2022; 8:140. [PMID: 35895227 PMCID: PMC9329500 DOI: 10.1186/s40792-022-01504-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 07/22/2022] [Indexed: 11/15/2022] Open
Abstract
Background Scoliosis is one of the symptoms manifested by patients with Marfan syndrome (MFS). Deformity of the thoracic cavity due to severe scoliosis may cause difficulty during cardiac surgery in terms of the surgical approach and instrument manipulation; however, only a few reports have been available regarding the surgical case of MFS with severe scoliosis. Here, we report a case of combined aortic valve replacement and left atrial appendage closure in a patient with MFS who had severe scoliosis using lower hemisternotomy. Case presentation A 62-year-old female with MFS was referred to our hospital after being diagnosed with severe aortic regurgitation and paroxysmal atrial fibrillation with a history of cerebral thromboembolism. The aortic valve showed severe insufficiency due to cusp prolapse, whereas the aortic root was moderately dilated (42 mm). Echocardiography revealed severe regurgitation with reduced left ventricular ejection function (32%) and massive left ventricular diastolic dimension (88 mm). Moreover, combined aortic valve replacement and left atrial appendage closure was indicated. However, the patient had chest deformity due to severe scoliosis. Thus, conventional full sternotomy or thoracotomy was considered an inappropriate surgical approach. Lower hemisternotomy was selected on the basis of three-dimensional reconstruction imaging of the aorta, left atrial appendage, sternum, and rib. Sternal elevation and rib retraction with the costal arch folded back provided enough surgical field for the combined procedures to be safely conducted. The postoperative course was uneventful, except for predicted prolonged mechanical ventilation with the assistance of intraaortic balloon pumping. Thereafter, the patient has been free from any cardiac and cerebrovascular event. Conclusions Lower hemisternotomy can be useful for combined cardiac surgery in MFS with severe scoliosis.
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Die superiore Ministernotomie – für welche Operationen? ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2022. [DOI: 10.1007/s00398-022-00501-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Boldyrev SY, Kaleda VI, Efremenko YV, Barbukhatti KO, Porkhanov VA. [Minimally invasive ascending aortic replacement in patient with chronic aortic dissection type A (in Russian only)]. Khirurgiia (Mosk) 2019:80-83. [PMID: 30938361 DOI: 10.17116/hirurgia201903180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
It is presented case report of minimally invasive surgical repair of chronic aortic dissection type A in a 61-year-old patient. Perspective minimally invasive surgical approach is suggested for this pathology in order to improve quality of life and rehabilitation after cardiac surgery. Surgical technique and features are comprehensively described.
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Affiliation(s)
- S Yu Boldyrev
- Research Institute 'Ochapovsky Regional Clinical Hospital #1', Krasnodar, Russia
| | - V I Kaleda
- Research Institute 'Ochapovsky Regional Clinical Hospital #1', Krasnodar, Russia
| | - Yu V Efremenko
- Research Institute 'Ochapovsky Regional Clinical Hospital #1', Krasnodar, Russia
| | - K O Barbukhatti
- Research Institute 'Ochapovsky Regional Clinical Hospital #1', Krasnodar, Russia
| | - V A Porkhanov
- Research Institute 'Ochapovsky Regional Clinical Hospital #1', Krasnodar, Russia
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Wanamaker KM, Hirji SA, Del Val FR, Yammine M, Lee J, McGurk S, Shekar P, Kaneko T. Proximal aortic surgery in the elderly population: Is advanced age a contraindication for surgery? J Thorac Cardiovasc Surg 2019; 157:53-63. [DOI: 10.1016/j.jtcvs.2018.04.100] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 03/29/2018] [Accepted: 04/23/2018] [Indexed: 11/29/2022]
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Karic A. Reversed L-type Upper Partial Sternotomy in Aortic Valve Replacement: an Initial Experience. Med Arch 2016; 70:229-31. [PMID: 27594754 PMCID: PMC5010060 DOI: 10.5455/medarh.2016.70.229-231] [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: 03/05/2016] [Accepted: 04/25/2016] [Indexed: 11/25/2022] Open
Abstract
Introduction: Degenerative aortic stenosis (AS) is the most frequent cause among aortic valve stenotic changes. Mini Sternotomy Aortic Valve Replacement is a replacement of aortic valve through upper partial sternotomy. Aim: The aim of this approach is to improve postoperative convalescence by leaving pleural spaces closed and do not compromise respiratory function, to decrease bleeding, and reduce post op ventilation time and ICU stay. All these advantages decrease cost during hospital stay by reducing ICU stay, respiration time, bleeding and using blood products, pain killers and shortening hospital stay. Esthetic effect is also considerable result of this method. Case report: This case report presents an initial experience with Reversed L-Type Upper Partial Sternotomy in Aortic Valve Replacement. The goal is to demonstrate that minimally invasive advanced cardiac surgery procedures can be performed in our country.
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Affiliation(s)
- Alen Karic
- Department of Cardiovascular surgery, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
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Vohra HA, Vaja R, Iakovakis I, Bapat V, Szostek J, Young C. Starting out in minimally invasive aortic valve replacement in the UK. Interact Cardiovasc Thorac Surg 2015; 22:1-4. [PMID: 26451000 DOI: 10.1093/icvts/ivv279] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 08/26/2015] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Here we aim to describe in detail the logical procedure and philosophical approach to establish a minimally access aortic valve replacement programme in the current era. METHODS A real example of a National Health Service Trust in the United Kingdom has been described in a step-wise manner. RESULTS The outcomes of the new procedure established in this fashion are reported and the philosophical lessons learnt from the experiences are highlighted. CONCLUSIONS It is hoped that this paper will act as a template for newly established surgeons to embark onto a mini-AVR programme. An open-minded and enthusiastic team will undoubtedly be able to facilitate the introduction of this 'new service'. A sensible approach will provide safe and sustainable outcomes.
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Affiliation(s)
- Hunaid A Vohra
- Department of Cardiac Surgery, University Hospitals Leicester, Glenfield Hospital, Leicester, UK
| | - Ricky Vaja
- Department of Cardiac Surgery, University Hospitals Leicester, Glenfield Hospital, Leicester, UK
| | - Ilias Iakovakis
- Department of Cardiac Surgery, University Hospitals Leicester, Glenfield Hospital, Leicester, UK
| | - Vinayak Bapat
- Department of Cardiac Surgery, St Thomas' Hospital, London, UK
| | - Jacek Szostek
- Department of Cardiac Surgery, University Hospitals Leicester, Glenfield Hospital, Leicester, UK
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Mikus E, Turci S, Calvi S, Ricci M, Dozza L, Del Giglio M. Aortic valve replacement through right minithoracotomy: is it really biologically minimally invasive? Ann Thorac Surg 2015; 99:826-30. [PMID: 25583466 DOI: 10.1016/j.athoracsur.2014.09.046] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 07/31/2014] [Accepted: 09/19/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Minimally invasive aortic valve replacement through a right mini-thoracotomy is a procedure developed in the past few years. Currently, the main limits of this technique are longer cardiopulmonary bypass time compared with the standard approach and the need for peripheral cannulation. METHODS From January 2010 to March 2014, 206 patients underwent an aortic valve replacement using a minimally invasive technique through a right mini-thoracotomy. Mean age was 71.4 ± 12.0 years, and 129 (62.6%) were male. In the first series of 42 patients, the vacuum-assisted venous drainage was obtained percutaneously through the groin. A totally central arterial and venous cannulation was adopted in the subsequent 164 patients. Two hundred patients (97.1%) received a bioprosthesis implanted with three 2-0 Prolene running sutures; a mechanical valve was implanted in six patients. One patient required reoperation. RESULTS Aortic valve replacement was performed through a 4-6-cm skin incision at the third intercostal space. Overall cardiopulmonary bypass was 64.8 ± 17.2 min, and aortic cross clamping was 51.8 ± 14.9 min. In-hospital mortality was 1.5% (3/206). CONCLUSIONS Our initial series confirms that aortic valve replacement performed through a right mini-thoracotomy is a safe procedure. When using running sutures, it is possible to obtain cardiopulmonary bypass and cross-clamping times comparable to those for the standard approach. A central cannulation can be performed easily to avoid groin incisions. In conclusion, we believe that this kind of surgery could really be a biologically minimally invasive approach, rather than just an aesthetic choice.
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Affiliation(s)
- Elisa Mikus
- Department of Cardiothoracic and Vascular Surgery, Maria Cecilia Hospital, GVM Care and Research, Cotignola, ES Health Science Foundation, Cotignola, Italy.
| | - Simone Turci
- Department of Cardiothoracic and Vascular Surgery, Villa Torri Hospital, GVM Care and Research, Bologna, ES Health Science Foundation, Cotignola, Italy
| | - Simone Calvi
- Department of Cardiothoracic and Vascular Surgery, Maria Cecilia Hospital, GVM Care and Research, Cotignola, ES Health Science Foundation, Cotignola, Italy
| | - Massimo Ricci
- Department of Cardiothoracic and Vascular Surgery, Villa Torri Hospital, GVM Care and Research, Bologna, ES Health Science Foundation, Cotignola, Italy
| | - Luca Dozza
- ES Health Science Foundation, Cotignola, Italy
| | - Mauro Del Giglio
- Department of Cardiothoracic and Vascular Surgery, Maria Cecilia Hospital, GVM Care and Research, Cotignola, ES Health Science Foundation, Cotignola, Italy; Department of Cardiothoracic and Vascular Surgery, Villa Torri Hospital, GVM Care and Research, Bologna, ES Health Science Foundation, Cotignola, Italy
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A 16-year experience in minimally invasive aortic valve replacement: context for the changing management of aortic valve disease. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2015; 9:104-10; discussion 110. [PMID: 24758946 DOI: 10.1097/imi.0000000000000053] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate short- and long-term morbidity and mortality in patients with aortic valve disease who had minimally invasive aortic valve replacement (AVR) through upper hemisternotomy. METHODS From July 1996 to June 2012, a total of 1639 patients underwent minimally invasive aortic valve surgery (AVR). Patient data were extracted from hospital electronic records after institutional review board approval. Outcomes of interest included postoperative complication rates, perioperative mortality, and long-term survival. RESULTS The mean age was 67 years (SD, 14 years; range, 22-95 years). Of the total cohort, 211 (13%) underwent reoperative AVR. Postoperatively, 2.3% (37/1639) had reoperations to correct bleeding, 2.7% (44/1639) had strokes, 20.4% (334/1639) had new-onset atrial fibrillation, and 1.5% (24/1639) required permanent pacemakers. Only 34% (571/1639) of the patients received packed red blood cells. The median discharge was on day 6 (5-8), and 72.2% of the patients (1184/1639) were discharged home. Operative mortality was 2.9% (48/1639), and long-term survival at 1, 5, 10, and 15 years was 96%, 93%, 92%, and 92%, respectively. Operative mortality was 5.7% (12/208) for the reoperative patients. CONCLUSIONS The upper hemisternotomy approach for AVR is safe and reliable, especially for patients undergoing reoperations and those older than 80 years.
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Raja SG, Benedetto U, Amrani M. Aortic valve replacement through J-shaped partial upper sternotomy. J Thorac Dis 2014; 5 Suppl 6:S662-8. [PMID: 24251025 DOI: 10.3978/j.issn.2072-1439.2013.10.02] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Accepted: 10/09/2013] [Indexed: 11/14/2022]
Abstract
The introduction of minimally invasive techniques in general surgery, in the late 1980s, influenced cardiac surgery as well. This led to the emergence of several minimal access approaches for aortic valve replacement (AVR). Currently, the upper partial sternotomy with unilateral J-shaped extension to the right through the fourth intercostal space is the most popular minimal access approach. This approach offers the comfort factor of sternotomy, improved cosmetic result, preserved respiratory mechanics, and last but not the least cost saving as no new equipment is required. On the other hand, inability to visualize the whole heart, adequately de-air the left heart, and failure to apply epicardial pacing wires are some of the perceived disadvantages of this approach. This article provides a comprehensive review of the indications, contraindications, technical aspects, outcomes, advantages and disadvantages of AVR through J-shaped partial upper sternotomy.
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Affiliation(s)
- Shahzad G Raja
- Department of Cardiac Surgery, Harefield Hospital, London, UK
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Seco M, Edelman JJB, Forrest P, Ng M, Wilson MK, Fraser J, Bannon PG, Vallely MP. Geriatric cardiac surgery: chronology vs. biology. Heart Lung Circ 2014; 23:794-801. [PMID: 24851829 DOI: 10.1016/j.hlc.2014.04.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Revised: 03/14/2014] [Accepted: 04/04/2014] [Indexed: 01/25/2023]
Abstract
Cardiac surgery is increasingly performed in elderly patients, and whilst the incidence of common risk factors associated with poorer outcome increases with age, recent studies suggest that outcomes in this population may be better than is widely appreciated. As such, in this review we have examined the current evidence for common cardiac surgical procedures in patients aged over 70 years. Coronary artery bypass grafting (CABG) in the elderly has similar early safety to percutaneous intervention, though repeat revascularisation is lower. Totally avoiding instrumentation of the ascending aorta with off-pump techniques may also reduce the incidence of neurological injury. Aortic valve replacement (AVR) significantly improves quality of life and provides excellent short- and long-term outcomes. Combined AVR and CABG carries higher risk but late survival is still excellent. Mini-sternotomy AVR in the elderly can provide comparable survival to full-sternotomy AVR. More accurate risk stratification systems are needed to appropriately select patients for transcatheter aortic valve implantation. Mitral valve repair is superior to replacement in the elderly, although choosing the most effective method is important for achieving maximal quality of life. Minimally-invasive mitral valve surgery in the elderly has similar postoperative outcomes to sternotomy-based surgery, but reduces hospital length of stay and return to activity. In operative candidates, surgical repair is superior to percutaneous repair. Current evidence indicates that advanced age alone is not a predictor of mortality or morbidity in cardiac surgery. Thus surgery should not be overlooked or denied to the elderly solely on the basis of their "chronological age", without considering the patient's true "biological age".
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Affiliation(s)
- Michael Seco
- Sydney Medical School, The University of Sydney, Sydney, Australia; The Baird Institute of Applied Heart & Lung Surgical Research, Sydney, Australia; Cardiothoracic Surgery Unit, Royal Prince Alfred Hospital, Sydney, Australia
| | - J James B Edelman
- The Baird Institute of Applied Heart & Lung Surgical Research, Sydney, Australia; Cardiothoracic Surgery Unit, Royal Prince Alfred Hospital, Sydney, Australia
| | - Paul Forrest
- Sydney Medical School, The University of Sydney, Sydney, Australia; Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney, Australia
| | - Martin Ng
- Sydney Medical School, The University of Sydney, Sydney, Australia; Cardiology Unit, Royal Prince Alfred Hospital, Sydney, Australia
| | - Michael K Wilson
- The Baird Institute of Applied Heart & Lung Surgical Research, Sydney, Australia; Cardiothoracic Surgery Unit, Royal Prince Alfred Hospital, Sydney, Australia; Australian School of Advanced Medicine, Macquarie University, Sydney, Australia
| | - John Fraser
- Critical Care Research Group, The Prince Charles Hospital, The University of Queensland
| | - Paul G Bannon
- Sydney Medical School, The University of Sydney, Sydney, Australia; The Baird Institute of Applied Heart & Lung Surgical Research, Sydney, Australia; Cardiothoracic Surgery Unit, Royal Prince Alfred Hospital, Sydney, Australia
| | - Michael P Vallely
- Sydney Medical School, The University of Sydney, Sydney, Australia; The Baird Institute of Applied Heart & Lung Surgical Research, Sydney, Australia; Cardiothoracic Surgery Unit, Royal Prince Alfred Hospital, Sydney, Australia; Australian School of Advanced Medicine, Macquarie University, Sydney, Australia.
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Gosev I, Kaneko T, McGurk S, McClure SR, Maloney A, Cohn LH. A 16-Year Experience in Minimally Invasive Aortic Valve Replacement. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2014. [DOI: 10.1177/155698451400900205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Igor Gosev
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA USA
| | - Tsuyoshi Kaneko
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA USA
| | - Siobhan McGurk
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA USA
| | - Scott R. McClure
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA USA
| | - Ann Maloney
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA USA
| | - Lawrence H. Cohn
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA USA
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Goldstone AB, Joseph Woo Y. Minimally Invasive Surgical Treatment of Valvular Heart Disease. Semin Thorac Cardiovasc Surg 2014; 26:36-43. [DOI: 10.1053/j.semtcvs.2014.02.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2014] [Indexed: 11/11/2022]
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McClure RS, Cohn LH. Minimally invasive surgery for aortic stenosis in the geriatric patient: where are we now? ACTA ACUST UNITED AC 2012. [DOI: 10.2217/ahe.11.84] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Minimally invasive aortic valve surgery has evolved with time and become the routine approach for aortic surgery in select surgical centers. The success of these procedures in the nonelderly has led some to embark on using minimal access techniques in the geriatric population as well. With the geriatric community often inflicted with the greatest disease burden, suffering not only from a valvular process but also cumulative comorbidities, geriatric patients may be the patients most likely to derive benefit from a minimally invasive approach. Alternative therapies for symptomatic aortic stenosis include conventional full-sternotomy aortic valve replacement in addition to transcatheter aortic valve implantation. Each option has its advantages and disadvantages. The role of minimal access aortic valve surgery and its impact on the progressively aging population in the face of conventional surgery and transcatheter technology is discussed.
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Affiliation(s)
- R Scott McClure
- Harvard Medical School, Division of Cardiac Surgery, Brigham & Women’s Hospital, Boston, MA 02115, USA
| | - Lawrence H Cohn
- Harvard Medical School, Division of Cardiac Surgery, Brigham & Women’s Hospital, Boston, MA 02115, USA
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Johnston WF, Ailawadi G. Surgical Management of Minimally Invasive Aortic Valve Operations. Semin Cardiothorac Vasc Anesth 2011; 16:41-51. [DOI: 10.1177/1089253211431647] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Although there is still a role for conventional sternotomy for aortic valve replacement, minimally invasive techniques are increasing in popularity and may benefit the patient with shorter postoperative course, less morbidity, and decreased overall cost. Additionally, transcatheter procedures have recently shown promising results in high-risk patients. This article provides an overview of the development of minimally invasive aortic valve operations, including a brief history of minimally invasive approaches, surgical considerations during minimally invasive aortic valve replacement, and the technical approach to performing a hemisternotomy with aortic valve replacement. In addition, the authors review transcatheter techniques, including aortic valve replacement via a sheath placed in the apex of the left ventricle or through a sheath placed in the femoral vessels. Finally, the exciting results of the PARTNER trial and the effect of these results on the future of aortic valve surgery are discussed.
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Affiliation(s)
| | - Gorav Ailawadi
- Department of Surgery, University of Virginia, Charlottesville, VA, USA
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15
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[Ministernotomy: a preliminary experience in heart valve surgery]. VOJNOSANIT PREGL 2011; 68:405-9. [PMID: 21744651 DOI: 10.2298/vsp1105405k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIM The last decade of the 20th century brought up a significant development in the field of minimally invasive approaches to the valvular heart surgery. Potential benefits of this method are: good esthetic appearance, reduced pain, reduction of postoperative hemorrhage and incidence of surgical site infection, shorter postoperative intensive care units (ICU) period and overall in-hospital period. Partial upper median stemotomy currently presents as a state-of-the art method for minimally invasive surgery of cardiac valves. The aim of this study was to report on initial experience in application of this surgical method in the surgery of mitral and aortic valves. METHODS The study was designed and conducted in a prospective manner and included all the patients who underwent minimally invasive cardiac valve surgery through the partial upper median stemotomy during the period November 2008 - August 2009. We analyzed the data on mean age of patients, mean extubation time, mean postoperative drainage, mean duration of hospital stay, as well as on occurance of postoperative complications (postoperative bleeding, surgical site infection and cerebrovascular insult). RESULTS During the observed period, in the Institute for Cardiovascular Diseases of Vojvodina, Clinic for Cardiovascular Surgery, 17 ministernotomies were performed, with 14 aortic valve replacements (82.35%) and 3 mitral valve replacements (17.65%). Mean age of the patients was 60.78 +/- 12.99 years (64.71% males, 35.29% females). Mean extubation time was 12.53 +/- 8.87 hours with 23.5% of the patients extubated in less than 8 hours. Mean duration of hospital stay was 12.35 +/- 10.17 days (in 29.4% of the patients less than 8 days). Mean postoperative drainage was 547.06 +/- 335.2 mL. Postoperative complications included: bleeding (5.88%) and cerebrovascular insult (5.88%). One patient (5.88%) required conversion to full stemotomy. CONCLUSION Partial upper median sternotomy represents the optimal surgical method for the interventions on the whole ascendant aorta (including aortic valve) and mitral valve through the roof of the left atrium, with a few significant advantages compared to the full stemotomy surgical approach.
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Salizzoni S, Bajona P, Zehr KJ, Anderson WD, Vandenberghe S, Speziali G. Transapical off-pump removal of the native aortic valve: a proof-of-concept animal study. J Thorac Cardiovasc Surg 2009; 138:468-73. [PMID: 19619797 DOI: 10.1016/j.jtcvs.2009.03.057] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2009] [Revised: 03/05/2009] [Accepted: 03/13/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study evaluates the feasibility of off-pump native aortic valve removal in preparation for transapical aortic valve replacement. Off-pump aortic valve replacement is performed by balloon predilatation of the native valve followed by insertion of a stented prosthesis. In patients with calcified annuli and cusps, particulate embolization, suboptimal prosthesis sizing, and perivalvular leaks may occur. Therefore, native valve removal may improve outcomes after transapical aortic valve replacement. METHODS The aortic cusps were sequentially removed from 10 pigs in an off-pump procedure. A temporary valve was inserted percutaneously into the ascending aorta to prevent aortic regurgitation. The electrocardiogram, coronary blood flow, and arterial, left atrial, and ventricular pressures were continuously monitored. RESULTS Removal of the aortic cusps caused a drop in diastolic arterial pressure and its equalization with left ventricular diastolic pressure. Systolic pressure decreased by 13.5%. Left atrial pressure increased by 86.0%. Coronary blood flow decreased by 39.9% and its pattern changed from mostly diastolic to mostly systolic. Electrocardiographic signs of ischemia appeared almost immediately. Percutaneous insertion of a temporary valve in the ascending aorta increased diastolic pressure and caused a tendency toward echocardiographic normalization. CONCLUSIONS Aortic valve removal in a healthy beating heart causes acute massive aortic regurgitation, hemodynamic instability, and the rapid onset of myocardial ischemia. Reduction of left ventricular volume overload, by placement of a temporary valve in the ascending aorta, mitigates myocardial distress, helps stabilize hemodynamic parameters, and may be a useful tool to allow surgical manipulations of the aortic valve and annulus during transapical aortic valve replacement procedures.
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Affiliation(s)
- Stefano Salizzoni
- Division of Cardiothoracic Surgery-Heart, Lung and Esophageal Surgery Institute, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
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Yilmaz A, Rehman A, Sonker U, Kloppenburg GT. Minimal Access Aortic Valve Replacement Using a Minimal Extracorporeal Circulatory System. Ann Thorac Surg 2009; 87:720-5. [DOI: 10.1016/j.athoracsur.2008.12.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2008] [Revised: 11/27/2008] [Accepted: 12/01/2008] [Indexed: 11/25/2022]
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Abstract
BACKGROUND Hemisternotomy has been suggested as a way to reduce morbidity by limiting the invasiveness of surgical interventions but it is often limited to aortic valve disease. This study reviews the experience of one center employing hemisternotomy and compares patient outcomes, both in-hospital and post-discharge, with a matched group of full sternotomy patients. METHODS Propensity scores were used to match all hemisternotomy valve cases (Hemi) to full sternotomy valve cases (Full) (1:2). An in-hospital composite outcome (COMP) was defined as mortality, stroke, deep sternal wound infection, sepsis, or return to operating room (OR) for bleeding or valve dysfunction. Provincial administrative health databases were used to determine freedom from mortality and hospital readmission for cardiac cause. RESULTS During the study period, 70 patients received hemisternotomy for various cardiac surgical interventions with only 38 patients undergoing isolated aortic valve replacement. Examining valve surgery exclusively, 65 Hemi were matched to 130 Full. In-hospital complications were low in both groups, with 1.0% mortality and a non-significant trend toward COMP in the Full group (Hemi=4.6%; Full=8.5%; p=0.39). Ventilation time was significantly decreased in Hemi (median four vs. six hours; p=0.002). At two years follow-up, survival was excellent for both (Hemi=95.0%; Full=93.6%) and freedom from cardiac morbidity (Hemi=76.8%, Full=73.2%) was comparable. CONCLUSION Hemisternotomy appears to be a safe, effective, and versatile alternative for many cardiac surgical interventions. With a median follow-up of four years, this study represents the longest cardiac morbidity follow-up for hemisternotomy patients. However, we were unable to conclusively show a morbidity benefit with this incision.
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Lee JW, Jung SH, Je HG. Minimally Invasive Cardiac Surgery. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2008. [DOI: 10.5124/jkma.2008.51.4.335] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Jae-Won Lee
- Department of Cardiovascular Surgery, University of Ulsan College of Medicine, Korea.
| | - Sung Ho Jung
- Department of Cardiovascular Surgery, University of Ulsan College of Medicine, Korea.
| | - Hyung Gon Je
- Department of Cardiovascular Surgery, University of Ulsan College of Medicine, Korea.
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Woo YJ, Seeburger J, Mohr FW. Minimally Invasive Valve Surgery. Semin Thorac Cardiovasc Surg 2007; 19:289-98. [DOI: 10.1053/j.semtcvs.2007.10.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2007] [Indexed: 11/11/2022]
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