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Wisneski AD, Nguyen TC. Myocardial Protection in Minimally Invasive Cardiac Surgery: Evolved Techniques for the New Era of Cardiac Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2022; 17:88-91. [PMID: 35322712 DOI: 10.1177/15569845221082546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Andrew D Wisneski
- Division of Cardiothoracic Surgery, Department of Surgery, 8785University of California San Francisco, CA, USA
| | - Tom C Nguyen
- Division of Cardiothoracic Surgery, Department of Surgery, 8785University of California San Francisco, CA, USA
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2
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Tamagnini G, Biondi R, Giglio MD. Aortic Valve Replacement Via Right Anterior Mini-Thoracotomy: the Conventional Procedure Performed Through a Smaller Incision. Braz J Cardiovasc Surg 2021; 36:120-124. [PMID: 33594866 PMCID: PMC7918393 DOI: 10.21470/1678-9741-2020-0165] [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] [Indexed: 11/08/2022] Open
Abstract
Minimally invasive aortic valve replacement has gained consent due to its good results in terms of minimized surgical trauma, faster rehabilitation, pain control and patient compliance. In our experience, we have tried to replicate the conventional and gold standard approach through a smaller incision. Sparing the right internal thoracic artery, avoiding rib fractures and performing total central cannulation is important to make this procedure minimally invasive from a biological point of view too. In addition, the total central cannulation is pivotal to simplify perfusion and drainage. Moreover, a complete step-by-step procedure optimization and-when possible-the use of sutureless prosthesis help to reduce the cross-clamping and perfusion times. After more than 1000 right anterior thoracotomy (RAT) aortic valve replacements, we have found tips and tricks to make our technique more effective.
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Affiliation(s)
| | - Raoul Biondi
- Department of Cardiac Surgery, Villa Torri Hospital, Bologna, Italy
| | - Mauro Del Giglio
- Department of Cardiac Surgery, Villa Torri Hospital, Bologna, Italy
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Bakhtiary F, El-Sayed Ahmad A, Amer M, Salamate S, Sirat S, Borger MA. Video-Assisted Minimally Invasive Aortic Valve Replacement Through Right Anterior Minithoracotomy for All Comers With Aortic Valve Disease. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2020; 16:169-174. [PMID: 33355012 DOI: 10.1177/1556984520977212] [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: 11/17/2022]
Abstract
OBJECTIVE Right anterior minithoracotomy is a promising technique for aortic valve replacement and has shown excellent results in terms of mortality and morbidity. Against this background, we analyzed our institutional experience in this technique during the last 3 years. METHODS Between April 2017 and March 2019, 513 consecutive all comers with aortic valve disease underwent video-assisted minimally invasive aortic valve replacement through a 3-cm skin incision as right anterior minithoracotomy at our institution. A camera and automatic fastener technology were used for the valve implantation in all patients. Clinical data were prospectively entered into our institutional database. RESULTS Cardiopulmonary bypass time accounted for 68 ± 24 min and the myocardial ischemic time 38 ± 12 minutes. Thirty-day mortality and overall mortality was 0.4% (2 patients) and 1.4% (7 patients), respectively. Postoperative cerebrovascular events were noted in 8 patients (1.5%). Intensive care stay and hospital stay were 2 ± 2 and 9 ± 7 days, respectively. Pacemaker implantation, injury of the right internal mammary artery, and conversion to full sternotomy were noted in 7 patients (1.4%), 3 patients (0.6%), and 1 patient (0.2%), respectively. Paravalvular leak need to intervention was noted in 2 patients (0.4%). Rethoracotomy rate was 2% (11 patients). Transient postoperative dialysis was necessary for 14 patients (3%). CONCLUSIONS Video-assisted minimally invasive aortic valve replacement through the right anterior minithoracotomy is a safe approach and yields excellent outcomes in high-volume centers. The use of a camera and automatic fastener technology facilitates this procedure.
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Affiliation(s)
- Farhad Bakhtiary
- 12263 Division of Cardiac Surgery, Heart Centre Siegburg-Wuppertal, University Witten-Herdecke, Germany
| | - Ali El-Sayed Ahmad
- 12263 Division of Cardiac Surgery, Heart Centre Siegburg-Wuppertal, University Witten-Herdecke, Germany
| | - Mohamed Amer
- 12263 Division of Cardiac Surgery, Heart Centre Siegburg-Wuppertal, University Witten-Herdecke, Germany
| | - Saad Salamate
- 12263 Division of Cardiac Surgery, Heart Centre Siegburg-Wuppertal, University Witten-Herdecke, Germany
| | - Sami Sirat
- 12263 Division of Cardiac Surgery, Heart Centre Siegburg-Wuppertal, University Witten-Herdecke, Germany
| | - Michael A Borger
- 40628 Division of Cardiac Surgery, University Clinic of Cardiac Surgery, Leipzig Heart Centre, Leipzig, Germany
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Missault S, Causenbroeck JV, Vandewiele K, Czapla J, Philipsen T, François K, Bové T. Analysis of clinical outcome and postoperative organ function effects in a propensity‐matched comparison between conventional and minimally invasive mitral valve surgery. J Card Surg 2020; 35:3276-3285. [DOI: 10.1111/jocs.15010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 08/18/2020] [Accepted: 08/27/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Sophie Missault
- Department of Cardiac Surgery University Hospital of Ghent Ghent Belgium
| | | | | | - Jens Czapla
- Department of Cardiac Surgery University Hospital of Ghent Ghent Belgium
| | - Tine Philipsen
- Department of Cardiac Surgery University Hospital of Ghent Ghent Belgium
| | - Katrien François
- Department of Cardiac Surgery University Hospital of Ghent Ghent Belgium
| | - Thierry Bové
- Department of Cardiac Surgery University Hospital of Ghent Ghent Belgium
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Zia K, Mangi AR, Bughio H, Tariq K, Chaudry PA, Karim M. Initial Experience of Minimally Invasive Concomitant Aortic and Mitral Valve Replacement/Repair at a Tertiary Care Cardiac Centre of a Developing Country. Cureus 2019; 11:e5707. [PMID: 31720175 PMCID: PMC6823070 DOI: 10.7759/cureus.5707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Minimally invasive double valve replacement (DVR) surgery through a small transverse anterior thoracotomy is an alternate technique to sternotomy for concomitant aortic and mitral valve (AVR, MVR) surgery. The aim of this study was to evaluate the in-hospital and early outcomes of direct vision minimal invasive double valve surgery (DVMI-DVR) at a tertiary care cardiac center of a developing country. Methods This study was conducted at the National Institute of Cardiovascular Diseases Karachi, Pakistan from January 2018 to September 2018. Nineteen consecutive patients undergoing DVMI-DVR for aortic and mitral disease without any prior cardiac surgery were included in this study. For all procedures, access was obtained through small transverse anterior thoracotomy incision with wedge resection (Chaudhry’s Wedge) of sternum opposite to the third and fourth costosternal joints. Patients were observed during their hospital stay and the following variables were observed the length of hospital stay (LOHS), ventilator support, intensive care unit (ICU) stay, pain score, and mortality. The pain score was assessed using the visual analog scale (VAS). Results The male/female ratio was 11:8 with a mean age of 35 ± 12 years with mean EuroSCORE of 6.6 ± 3.5%. The mean total bypass time was 129.8 ± 23.83 min (range: 98-181 minutes). The mean mechanical ventilation time was 3.16 ± 1.12 hours (range: 2-6 hours). The mean intensive care unit (ICU) stay was 41.84 ± 8.36 hours. The mean post-operative LOHS was 5.63 ± 1.12 days (range: 4-8 days). We had zero frequency of wound infection and surgical mortality. The mean pain score was 4.32 (on a predefined pain scale of one to nine with a high value indicating severe pain). Conclusion Minimally invasive DVR surgery is a safe and reproducible technique with comparable outcomes such as postoperative pain score (4.32 ± 2.05), ventilation time (3.16 ± 1.12 hours), ICU stay (41.84 ± 8.36 hours), and hospital stay (5.63 ± 1.12 days). In terms of mortality, operative times, ICU stay, and hospital stay, the minimally invasive DVR is at least comparable to those achieved with median sternotomy. Further prospective randomized studies are needed to validate our findings.
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Affiliation(s)
- Kashif Zia
- Cardiac Surgery, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Ali R Mangi
- Cardiac Surgery, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Hafeezullah Bughio
- Cardiac Surgery, National Institute of Cardiovascular Disease, Karachi, PAK
| | - Khuzaima Tariq
- Cardiac Surgery, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Pervaiz A Chaudry
- Cardiac Surgery, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Musa Karim
- Miscellaneous, National Institute of Cardiovascular Diseases, Karachi, PAK
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Abstract
Objective: All innovations in cardiac surgery provide us with new techniques to perform surgery through smaller incisions with less invasive and best cosmetic results. After promising results in minimally invasive cardiac surgery (MICS), pain and cosmetic appearance became important end points, especially for female patients. In the current study, we intended to evaluate the surgical results and cosmetic satisfaction with the periareolar and submammary incision types in cardiac surgery. Methods: Ninety-four female patients underwent MICS between July 2013 and March 2018. MICS was performed in 62 patients via periareolar incision and in 32 patients via submammarian incision. We investigated the incision size, wound infection, pain levels by using a postoperative standard pain-level questionnaire, the postoperative scar size, and patient satisfaction using a postoperative patient questionnaire. Results: Periareolar incision size was smaller than the submammary incision (Group A: 5.6±0.6 vs. Group B: 6.7±0.8, p=0.001). Four patients from Group B had superficial wound infection (p=0.01). Patients who underwent MICS via periareolar incision and submammary incision had similar pain level (p=0.2). The scar tissue was smaller in size and postoperatively healed better in the following days for the patients with periareolar incision due to the elastic structure of breast tissue. (Group A: 4.3±0.4 vs. Group B: 5.3±0.2, p=0.001). Conclusion: Our study suggests that the periareolar approach would be more aesthetic, show better healing, and have a smaller scar size in female patients.
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Ribeiro IB, Ruel M. Right Anterior Minithoracotomy for Aortic Valve Replacement: A Widely Applicable, Simple, and Stepwise Approach. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2019; 14:321-329. [DOI: 10.1177/1556984519844745] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective A stepwise approach for right anterior minithoracotomy aortic valve replacement (RAT-AVR), without sutureless valves, special instruments, or preoperative imaging, was developed. We report our experience with this widely applicable, simplified approach. Methods Patients with a history of previous chest surgery, documented PVD, severe COPD, LVOT size <2.0 cm, and root size <2.8 cm were excluded. Chest CT was not mandatory. The stepwise surgical approach consists of 1) tolerability of single-lung ventilation; 2) 5-cm long incision on third right anterior ICS; 3) small pericardial opening to localize the aortic valve annular plane by digital palpation; 4) shingling of the correct rib to create a box field; 5) optimizing exposure with stay sutures; 6) femoral or central cannulation with right superior pulmonary vein venting and usual antegrade cardioplegia; 7) performing a standard AVR without adjunct instruments; and 8) reconstructing 1 costochondral cartilage. Results Fifty-five patients were operated. The mean age was 68.5 years (SD 10.4); 29.1% were female. Median STS PROM was 1.18 (0.4 to 6.6). Pump and cross-clamp times were 104.8 minutes (SD 27.9) and 73.2 minutes (SD 22.8), respectively. There was no need for a knot pusher. There was 1 conversion, 1 reopening for bleeding, and 1 pacemaker insertion. No patient had a stroke, MI, or death at 30 days. The median LOS was 6 days (3 to 19). Conclusion RAT-AVR can be applicable and performed safely in a wide range of patients by adopting a simple, stepwise approach with intraoperative assessment, without the need for special imaging, instrumentation, or advanced training.
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Affiliation(s)
- Igo B. Ribeiro
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Canada
| | - Marc Ruel
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Canada
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Upper Ministernotomy for Pulmonary Valve Repair. Ann Thorac Surg 2019; 107:e305-e306. [DOI: 10.1016/j.athoracsur.2018.09.054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 08/29/2018] [Accepted: 09/16/2018] [Indexed: 11/22/2022]
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Elattar MA, Kaya A, Planken NR, Baan J, Vanbavel ET, de Mol BAJM, Marquering HA. A computed tomography-based planning tool for predicting difficulty of minimally invasive aortic valve replacement. Interact Cardiovasc Thorac Surg 2018; 27:505-511. [PMID: 29659843 DOI: 10.1093/icvts/ivy128] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 03/21/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Minimally invasive aortic valve replacement has proven its value over the last decade by its significant advancement and reduction in mortality, morbidity and admission time. However, minimally invasive aortic valve replacement is associated with some on-site difficulties such as limited aortic annulus exposure. Currently, computed tomography scans are used to evaluate the anatomical relationship among the intercostal spaces, ascending aorta and aortic valve prior to surgery. We hypothesized that quantitative measurements of access distance and access angle are associated with outcome and access difficulty. METHODS We introduce a novel minimally invasive aortic valve replacement planning prototype that allows automatic measurements of access angle, access distance and aortic annulus dimensions. The prototype visualizes these measurements on the chest cage as ISO contours. The association of these measures with outcome parameters such as extracorporeal circulation time, aortic cross-clamping time and access difficulty score was assessed. We included 14 patients who received a new valve by ministernotomy. RESULTS The mean access angle was 40.3 ± 5.1°. It was strongly associated with aortic cross-clamping time (Pearson correlation coefficient = 0.60, P = 0.02) and access difficulty score (Spearman's rank correlation coefficient = 0.57, P = 0.03). Access angles were significantly different between easy and difficult access groups (P = 0.03). There was no significant association between access distance and outcome parameters. CONCLUSIONS Access angle is strongly associated with procedure complexity. The automated presentation of this measure suggests added value of the prototype in clinical practice.
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Affiliation(s)
- Mustafa A Elattar
- Department of Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.,Department of Informatics Science, Communication and Information Technology School, Nile University, Giza, Egypt
| | - Abdullah Kaya
- Department of Cardiothoracic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Nils R Planken
- Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Jan Baan
- Department of Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Ed T Vanbavel
- Department of Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Bas A J M de Mol
- Department of Cardiothoracic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.,Department of Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Henk A Marquering
- Department of Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.,Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
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Minimally Invasive Direct Access Balloon-Expandable Transcatheter Mitral Valve Replacement for Extensive Mitral Annular Calcification after Transcatheter Aortic Valve Replacement. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2018; 13:222-225. [DOI: 10.1097/imi.0000000000000496] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Mitral annular calcification can pose a formidable surgical challenge in the setting of mitral valve replacement for mitral stenosis. Although there are reports of transapical valve-in-valve transcatheter mitral valve replacement in the setting of degenerated bioprosthetic mitral valve replacement, there is less experience with transcatheter mitral valve replacement for mitral annular calcification. This report describes a patient who previously received a transcatheter aortic valve replacement and then subsequently underwent a minimally invasive right thoracotomy for transcatheter mitral valve replacement with a successful result. We discuss technical pearls and operative considerations based on an extensive experience with minimally invasive valve surgery from a right mini-thoracotomy.
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11
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Lamelas J, Silva GV, Chatterjee S. Minimally Invasive Direct Access Balloon-Expandable Transcatheter Mitral Valve Replacement for Extensive Mitral Annular Calcification after Transcatheter Aortic Valve Replacement. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2018. [DOI: 10.1177/155698451801300311] [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]
Affiliation(s)
- Joseph Lamelas
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine and Texas Heart Institute at CHI Baylor St. Luke's Medical Center, Houston, TX USA
| | - Guilherme V. Silva
- Division of Cardiology, Department of Medicine, Baylor College of Medicine and Texas Heart Institute at CHI Baylor St. Luke's Medical Center, Houston, TX USA
| | - Subhasis Chatterjee
- Division of General and Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine and Texas Heart Institute at CHI Baylor St. Luke's Medical Center, Houston, TX USA
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Poffo R, Montanhesi PK, Toschi AP, Pope RB, Mokross CA. Periareolar Access for Minimally Invasive Cardiac Surgery the Brazilian Technique. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2018; 13:65-69. [DOI: 10.1097/imi.0000000000000454] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The periareolar access has been the preferred technique used at our institution for minimally invasive cardiac surgery since 2006. The surgical approach consists of video-assisted minithoracotomy in the 4th right intercostal space, through a periareolar incision. Initially, the technique was restricted to minimally invasive mitral valve surgeries but, due to its feasibility and safety, was soon incorporated as an ideal access for other cardiac pathologies such as tricuspid valve disease, atrial septal defect, atrial fibrillation, and pacemaker leads endocarditis. The technique was performed in 214 patients, and it is associated with excellent aesthetic and functional results, with low morbimortality and no reoperations at long-term follow-up. Here, we describe and support the use of periareolar access as a routine surgical technique for correction of several cardiac pathologies, especially in women.
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Affiliation(s)
- Robinson Poffo
- Minimally Invasive and Robotic Cardiac Surgery
Center, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Paola K. Montanhesi
- Minimally Invasive and Robotic Cardiac Surgery
Center, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Alisson P. Toschi
- Minimally Invasive and Robotic Cardiac Surgery
Center, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Renato B. Pope
- Minimally Invasive and Robotic Cardiac Surgery
Center, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Cláudio A. Mokross
- Minimally Invasive and Robotic Cardiac Surgery
Center, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
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Poffo R, Montanhesi PK, Toschi AP, Pope RB, Mokross CA. Periareolar Access for Minimally Invasive Cardiac Surgery the Brazilian Technique. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2018. [DOI: 10.1177/155698451801300114] [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]
Affiliation(s)
- Robinson Poffo
- Minimally Invasive and Robotic Cardiac Surgery Center, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Paola K. Montanhesi
- Minimally Invasive and Robotic Cardiac Surgery Center, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Alisson P. Toschi
- Minimally Invasive and Robotic Cardiac Surgery Center, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Renato B. Pope
- Minimally Invasive and Robotic Cardiac Surgery Center, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Cláudio A. Mokross
- Minimally Invasive and Robotic Cardiac Surgery Center, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
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Preoperative determination of artificial chordae length with 320-slice computed tomographic images. J Thorac Cardiovasc Surg 2017; 154:1634-1637. [DOI: 10.1016/j.jtcvs.2017.06.054] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 05/31/2017] [Accepted: 06/26/2017] [Indexed: 11/21/2022]
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Cao H, Zhou Q, Fan F, Xue Y, Pan J, Wang D. Right anterolateral thoracotomy: an attractive alternative to repeat sternotomy for high-risk patients undergoing reoperative mitral and tricuspid valve surgery. J Cardiothorac Surg 2017; 12:85. [PMID: 28934975 PMCID: PMC5609070 DOI: 10.1186/s13019-017-0645-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 08/29/2017] [Indexed: 01/24/2023] Open
Abstract
Background Reoperative cardiac valve surgery via sternotomy is associated with a substantial morbidity and mortality. This study evaluated the right anterolateral thoracotomy for high-risk patients undergoing mitral and tricuspid valve redo procedures. Methods Out of a series of 173 patients undergoing redo cardiac valve surgery, 24 patients were reoperative via the right anterolateral thoracotomy as the high-risk group on the basis of the proximity of the heart and great vessels to the sternum and the presence and location of patent bypass grafts. Results In all cases, sternotomy was avoided. The mitral valve and tricuspid valve were replaced in 4 and 19 patients and repaired in 1 and 2 patients, respectively. Moreover, left atrial folding was performed in 5 patients. Mortality was 8.3%. All other patients had uneventful outcomes and normal valve function at follow-up. Conclusions Reoperative cardiac valve surgery can be performed safely using the right anterolateral thoracotomy in high-risk patients. It offers enough exposure. It minimizes the need for cardiac dissection, and thus, the risk for injury. Avoiding a high-risk resternotomy increases patients comfort and safety of redo mitral and tricuspid valve surgery. Electronic supplementary material The online version of this article (10.1186/s13019-017-0645-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hailong Cao
- Department of Thoracic and Cardiovascular Surgery, the Affiliated Drum Tower Hospital of Nanjing, University Medical School, 321 Zhongshan RD, Nanjing, 210008, China
| | - Qing Zhou
- Department of Thoracic and Cardiovascular Surgery, the Affiliated Drum Tower Hospital of Nanjing, University Medical School, 321 Zhongshan RD, Nanjing, 210008, China
| | - Fudong Fan
- Department of Thoracic and Cardiovascular Surgery, the Affiliated Drum Tower Hospital of Nanjing, University Medical School, 321 Zhongshan RD, Nanjing, 210008, China
| | - Yunxing Xue
- Department of Thoracic and Cardiovascular Surgery, the Affiliated Drum Tower Hospital of Nanjing, University Medical School, 321 Zhongshan RD, Nanjing, 210008, China
| | - Jun Pan
- Department of Thoracic and Cardiovascular Surgery, the Affiliated Drum Tower Hospital of Nanjing, University Medical School, 321 Zhongshan RD, Nanjing, 210008, China
| | - Dongjin Wang
- Department of Thoracic and Cardiovascular Surgery, the Affiliated Drum Tower Hospital of Nanjing, University Medical School, 321 Zhongshan RD, Nanjing, 210008, China.
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Chamos C, Yates M, Austin S, Bapat V. Minimally Invasive Aortic Valve Replacement in a Patient With Severe Hemophilia A. J Cardiothorac Vasc Anesth 2017; 31:1378-1380. [DOI: 10.1053/j.jvca.2016.11.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Indexed: 11/11/2022]
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Respiratory functional status after conventional and minimally invasive aortic valve replacement surgery - a propensity score analysis. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2017; 14:5-9. [PMID: 28515741 PMCID: PMC5404120 DOI: 10.5114/kitp.2017.66922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 02/15/2017] [Indexed: 11/26/2022]
Abstract
Introduction Reports describing respiratory function of patients after conventional or minimally invasive cardiac surgery are infrequent. Aim To compare pulmonary functional status after conventional (AVR) and after minimally invasive, through right anterior minithoracotomy, aortic valve replacement (RT-AVR). Material and methods This was an observational analysis of 212 patients scheduled for RT-AVR and 212 for AVR between January 2011 and December 2014 selected using propensity score matching. Respiratory function based on spirometry examinations is presented. Results Hospital mortality was 1.4% in RT-AVR and 1.9% in AVR (p = 0.777). Predicted mortality (EuroSCORE II) was 3.2 ±1.1% in RT-AVR and 3.1 ±1.6% in AVR (p = 0.298). Mechanical ventilation time in intensive care unit (ICU) was 7.3 ±3.9 h for RT-AVR and 9.6 ±5.5 h for AVR patients (p < 0.001). Seven days and 1 month after surgery, the reduction of spirometry functional tests was greater in the AVR group than in the RT-AVR group (p < 0.001). Three months after surgery, all spirometry parameters were still reduced and had not returned to preoperative values in both RT-AVR and AVR groups. However, the difference in spirometry values was no longer statistically significant between RT-AVR and AVR groups. Presence of chronic obstructive pulmonary disease and conventional AVR surgical technique were associated with lower values of spirometry parameters after surgery in linear median regression. Conclusions Respiratory function based on spirometry examinations was less impaired after minimally invasive RT-AVR surgery in comparison to conventional AVR surgery through median sternotomy.
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Respiratory System Function in Patients after Minimally Invasive Aortic Valve Replacement Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017; 12:127-136. [DOI: 10.1097/imi.0000000000000349] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objective The aim of the study was to comparatively analyze respiratory system function after minimally invasive, through right minithoracotomy aortic valve replacement (RT-AVR) to conventional AVR. Methods Analysis of 201 patients scheduled for RT-AVR and 316 for AVR between January 2010 and November 2013. Complications of the respiratory system and pulmonary functional status are presented. Results Complications of the respiratory system occurred in 16.8% of AVR and 11.0% of RT-AVR patients ( P = 0.067). The rate of pleural effusions, thoracenteses, pneumonias, or phrenic nerve dysfunctions was not significantly different between groups. Perioperative mortality was 1.9% in AVR and 1.0% in RT-AVR ( P = 0.417). Mechanical ventilation time after surgery was 9.7 ± 5.9 hours for AVR and 7.2 ±3.2 hours for RT-AVR patients ( P < 0.001). Stroke (odds ratio [OR] = 13.4, P = 0.008), increased postoperative blood loss (OR = 9.6, P <0.001), and chronic obstructive pulmonary disease (OR = 7.7, P < 0.001) were risk factors of prolonged mechanical lung ventilation. A week after surgery, the results of most pulmonary function tests were lower in the AVR than in the RT-AVR group ( P < 0.001 was seen for forced expiratory volume in the first second, vital capacity, total lung capacity, maximum inspiratory pressure and maximum expiratory pressure, P = 0.377 was seen for residual volume). Conclusions Right anterior aortic valve replacement minithoracotomy surgery with single-lung ventilation did not result in increased rate of respiratory system complications. Spirometry examinations revealed that pulmonary functional status was more impaired after AVR in comparison with RT-AVR surgery.
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Stoliński J, Musiał R, Plicner D, Andres J. Respiratory System Function in Patients after Minimally Invasive Aortic Valve Replacement Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017. [DOI: 10.1177/155698451701200209] [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]
Affiliation(s)
- Jarosław Stoliński
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University of Cracow, John Paul II Hospital, Cracow, Poland
| | - Robert Musiał
- Department of Anaesthesiology and Intensive Therapy, Jagiellonian University of Cracow, John Paul II Hospital, Cracow, Poland
| | - Dariusz Plicner
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University of Cracow, John Paul II Hospital, Cracow, Poland
| | - Janusz Andres
- Department of Anaesthesiology and Intensive Therapy, Jagiellonian University of Cracow, John Paul II Hospital, Cracow, Poland
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Richau J, Dieringer MA, Traber J, von Knobelsdorff-Brenkenhoff F, Greiser A, Schwenke C, Schulz-Menger J. Effects of heart valve prostheses on phase contrast flow measurements in Cardiovascular Magnetic Resonance - a phantom study. J Cardiovasc Magn Reson 2017; 19:5. [PMID: 28088917 PMCID: PMC5238524 DOI: 10.1186/s12968-016-0319-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 12/21/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Cardiovascular Magnetic Resonance is often used to evaluate patients after heart valve replacement. This study systematically analyses the influence of heart valve prostheses on phase contrast measurements in a phantom trial. METHODS Two biological and one mechanical aortic valve prostheses were integrated in a flow phantom. B0 maps and phase contrast measurements were acquired at a 1.5 T MR scanner using conventional gradient-echo sequences in predefined distances to the prostheses. Results were compared to measurements with a synthetic metal-free aortic valve. RESULTS The flow results at the level of the prosthesis differed significantly from the reference flow acquired before the level of the prosthesis. The maximum flow miscalculation was 154 ml/s for one of the biological prostheses and 140 ml/s for the mechanical prosthesis. Measurements with the synthetic aortic valve did not show significant deviations. Flow values measured approximately 20 mm distal to the level of the prosthesis agreed with the reference flow for all tested all prostheses. CONCLUSIONS The tested heart valve prostheses lead to a significant deviation of the measured flow rates compared to a reference. A distance of 20 mm was effective in our setting to avoid this influence.
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Affiliation(s)
- Johanna Richau
- Working Group on Cardiovascular Magnetic Resonance Imaging, Experimental and Clinical Research Center, joint cooperation of the Max-Delbrück-Centrum and Charité -Medical University Berlin, Berlin, Germany
| | | | - Julius Traber
- Working Group on Cardiovascular Magnetic Resonance Imaging, Experimental and Clinical Research Center, joint cooperation of the Max-Delbrück-Centrum and Charité -Medical University Berlin, Berlin, Germany
- HELIOS Klinikum Berlin-Buch, Department of Cardiology and Nephrology, Berlin, Germany
| | - Florian von Knobelsdorff-Brenkenhoff
- Working Group on Cardiovascular Magnetic Resonance Imaging, Experimental and Clinical Research Center, joint cooperation of the Max-Delbrück-Centrum and Charité -Medical University Berlin, Berlin, Germany
- HELIOS Klinikum Berlin-Buch, Department of Cardiology and Nephrology, Berlin, Germany
- Department of Cardiology, Clinic Agatharied, Ludwig-Maximilians-University Munich, Hausham, Germany
| | | | | | - Jeanette Schulz-Menger
- Working Group on Cardiovascular Magnetic Resonance Imaging, Experimental and Clinical Research Center, joint cooperation of the Max-Delbrück-Centrum and Charité -Medical University Berlin, Berlin, Germany.
- HELIOS Klinikum Berlin-Buch, Department of Cardiology and Nephrology, Berlin, Germany.
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Spadaccio C, Nappi F, Sablayrolles JL, Sutherland FW. TAVR vs SAVR: Rising Expectations and Changing Indications for Surgery in Response to PARTNER II. Semin Thorac Cardiovasc Surg 2017; 29:8-11. [DOI: 10.1053/j.semtcvs.2017.01.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2017] [Indexed: 12/23/2022]
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22
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Heijmans JH, Lancé MD. Fast track minimally invasive aortic valve surgery: patient selection and optimizing. Eur Heart J Suppl 2017. [DOI: 10.1093/eurheartj/suw056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Elattar MA, van Kesteren F, Wiegerinck EM, Vanbavel E, Baan J, Cocchieri R, de Mol B, Planken NR, Marquering HA. Automated CTA based measurements for planning support of minimally invasive aortic valve replacement surgery. Med Eng Phys 2016; 39:123-128. [PMID: 27913175 DOI: 10.1016/j.medengphy.2016.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 11/03/2016] [Accepted: 11/14/2016] [Indexed: 11/27/2022]
Abstract
Minimally invasive aortic valve replacement (mini-AVR) procedures are a valuable alternative to conventional open heart surgery. Currently, planning of mini-AVR consists of selection of the intercostal space closest to the sinotubular junction on preoperative computer tomography images. We developed an automated algorithm detecting the sinotubular junction (STJ) and intercostal spaces for finding the optimal incision location. The accuracy of the STJ detection was assessed by comparison with manual delineation by measuring the Euclidean distance between the manually and automatically detected points. In all 20 patients, the intercostal spaces were accurately detected. The median distance between automated and manually detected STJ locations was 1.4 [IQR= 0.91-4.7] mm compared to the interobserver variation of 1.0 [IQR= 0.54-1.3] mm. For 60% of patients, the fourth intercostal space was the closest to the STJ. The proposed algorithm is the first automated approach for detecting optimal incision location and has the potential to be implemented in clinical practice for planning of various mini-AVR procedures.
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Affiliation(s)
- Mustafa A Elattar
- Department of Biomedical Engineering and Physics, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - Floortje van Kesteren
- Departments of Radiology, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; Department of Heart Center, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Esther M Wiegerinck
- Department of Heart Center, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Ed Vanbavel
- Department of Biomedical Engineering and Physics, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Jan Baan
- Department of Heart Center, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Riccardo Cocchieri
- Department of Heart Center, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Bas de Mol
- Department of Heart Center, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Nils R Planken
- Departments of Radiology, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Henk A Marquering
- Department of Biomedical Engineering and Physics, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; Departments of Radiology, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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Stoliński J, Plicner D, Grudzień G, Wąsowicz M, Musiał R, Andres J, Kapelak B. A comparison of minimally invasive and standard aortic valve replacement. J Thorac Cardiovasc Surg 2016; 152:1030-9. [PMID: 27449562 DOI: 10.1016/j.jtcvs.2016.06.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 05/20/2016] [Accepted: 06/12/2016] [Indexed: 01/23/2023]
Abstract
OBJECTIVE The study objective was to compare aortic valve replacement through a right anterior minithoracotomy with aortic valve replacement through a median sternotomy. METHODS With propensity score matching, we selected 211 patients after aortic valve replacement through a right anterior minithoracotomy and 211 patients after aortic valve replacement who underwent operation between January 2010 and December 2013. Perioperative outcomes were analyzed, and multivariable logistic regression analysis of risk factors of postoperative morbidity was performed. RESULTS For propensity score-matched patients, hospital mortality was 1.0% in the aortic valve replacement through a right anterior minithoracotomy group and 1.4% in the aortic valve replacement group (P = 1.000). Stroke occurred in 0.5% versus 1.4% (P = .615), myocardial infarction occurred in 1.4% versus 1.9% (P = 1.000), and new onset of atrial fibrillation occurred in 12.8% versus 24.2% (P = .003) of patients in the aortic valve replacement through a right anterior minithoracotomy and aortic valve replacement groups, respectively. Postoperative drainage was 353.5 ± 248.6 mL versus 544.3 ± 324.5 mL (P < .001) and blood transfusion was required for 48.8% versus 67.3% (P < .001) of patients in the aortic valve replacement through a right anterior minithoracotomy and aortic valve replacement groups, respectively. Mediastinitis occurred in 2.8% of patients after aortic valve replacement and in 0.0% of patients after aortic valve replacement through a right anterior minithoracotomy surgery (P = .040). Intensive care unit stay (1.3 ± 1.2 days vs 2.6 ± 2.6 days) and hospital stay (5.7 ± 1.6 days vs 8.7 ± 4.4 days) were statistically significantly shorter in the aortic valve replacement through a right anterior minithoracotomy group. Aortic valve replacement through a right anterior minithoracotomy surgery resulted in reduced postoperative morbidity (odds ratio, 0.4; P < .001) and postoperative bleeding and blood transfusion requirements (odds ratio, 0.4; P < .001). CONCLUSIONS Aortic valve replacement through a right anterior minithoracotomy surgery resulted in a reduced infection rate, diminished postoperative bleeding and blood transfusion requirements, reduced occurrence of new onset of atrial fibrillation, and shorter intensive care unit and hospital stays.
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Affiliation(s)
- Jarosław Stoliński
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University in Cracow, John Paul II Hospital, Cracow, Poland.
| | - Dariusz Plicner
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University in Cracow, John Paul II Hospital, Cracow, Poland
| | - Grzegorz Grudzień
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University in Cracow, John Paul II Hospital, Cracow, Poland
| | - Marcin Wąsowicz
- Department of Anesthesia and Pain Management, Toronto General Hospital, Department of Anesthesia, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Robert Musiał
- Department of Anesthesiology and Intensive Therapy, Jagiellonian University in Cracow, John Paul II Hospital, Cracow, Poland
| | - Janusz Andres
- Department of Anesthesiology and Intensive Therapy, Jagiellonian University in Cracow, John Paul II Hospital, Cracow, Poland
| | - Bogusław Kapelak
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University in Cracow, John Paul II Hospital, Cracow, Poland
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Surgery for acquired cardiac disease: An evolving paradigm with a promising future. J Thorac Cardiovasc Surg 2016; 151:1466-9. [PMID: 27207120 DOI: 10.1016/j.jtcvs.2016.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 10/16/2015] [Accepted: 01/05/2016] [Indexed: 11/22/2022]
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Ramakrishna H, Patel PA, Gutsche JT, Vallabhajosyula P, Szeto WY, MacKay E, Feinman JW, Shah R, Zhou E, Weiss SJ, Augoustides JG. Surgical Aortic Valve Replacement-Clinical Update on Recent Advances in the Contemporary Era. J Cardiothorac Vasc Anesth 2016; 30:1733-1741. [PMID: 27542900 DOI: 10.1053/j.jvca.2016.04.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic, Phoenix, AZ
| | | | | | - Prashanth Vallabhajosyula
- Division of Cardiovascular Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Wilson Y Szeto
- Division of Cardiovascular Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | | | - Ronak Shah
- Department of Anesthesiology and Critical Care
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Holmes SD, Fornaresio LM, Shuman DJ, Pritchard G, Ad N. Health-Related Quality of Life after Minimally Invasive Cardiac Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2016; 11:128-33. [DOI: 10.1097/imi.0000000000000255] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objective Factors influencing health-related quality of life (HRQL) after minimally invasive cardiac surgery have not been well described. We examined the trajectory of HRQL after minimally invasive cardiac surgery and the role of perioperative factors and rhythm on HRQL changes. Methods Patients underwent minimally invasive surgical ablation for atrial fibrillation and/or valve surgery (n = 235). Health-related quality of life (SF-12) and clinical status were assessed preoperatively and postoperatively. Results Physical summary HRQL (F = 36.2, P < 0.001) and mental summary HRQL (F = 3.2, P = 0.047) improved significantly by 12 months after surgery. Improvement on HRQL peaked at 6 months and plateaued between 6 and 12 months. Physical HRQL was similar to age-based normal values before surgery (P = 0.66) and surpassed norms by 6 months after surgery (P < 0.001). Younger age (r = −0.15, P = 0.02) and lower EuroSCORE II (r = −0.19, P = 0.003) correlated with greater HRQL improvements by 6 months. Only lower EuroSCORE II (r = −0.14, P = 0.04) correlated with greater HRQL improvement by 12 months. Length of stay and major morbidity were not related to HRQL improvement. In surgical ablation patients, restoration of stable sinus rhythm throughout the first 12 months was associated with greater physical HRQL improvement by 6 months compared with patients who had atrial arrhythmia recurrences (change, 5.0 vs. −1.0, P = 0.02). Conclusions Health-related quality of life improved significantly after minimally invasive cardiac surgery. These improvements were influenced by age, operative risk, symptoms, and rhythm status. Even patients with HRQL in a normal range before surgery can experience improved HRQL after surgery. Minimally invasive cardiac surgery can offer decreased postoperative complications and also improved HRQL.
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Affiliation(s)
- Sari D. Holmes
- Inova Heart and Vascular Institute, Falls Church, VA USA
| | | | | | | | - Niv Ad
- Inova Heart and Vascular Institute, Falls Church, VA USA
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Holmes SD, Fornaresio LM, Shuman DJ, Pritchard G, Ad N. Health-Related Quality of Life after Minimally Invasive Cardiac Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2016. [DOI: 10.1177/155698451601100209] [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]
Affiliation(s)
- Sari D. Holmes
- Inova Heart and Vascular Institute, Falls Church, VA USA
| | | | | | | | - Niv Ad
- Inova Heart and Vascular Institute, Falls Church, VA USA
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Boix-Garibo R, Uzzaman MM, Bapat VN. Review of Minimally Invasive Aortic Valve Surgery. Interv Cardiol 2015; 10:144-148. [PMID: 29588692 DOI: 10.15420/icr.2015.10.03.144] [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] [Indexed: 12/13/2022] Open
Abstract
Minimally invasive aortic valve surgery (MIAVS) has been developed for the last 20 years. The improvements in techniques have permitted cardiac surgeons to perform aortic valve replacement safely and efficiently with minimally incisions. Patients have become older and have multiple comorbidities and this is expected to grow in number. Less-invasive procedures are known to reduce the number of complications, together with smaller incisions, less pain, less blood loss and reduced length of hospital stay. Selective preoperative planning with computed tomography is key to the pre-investigation stage. Hybrid and staged procedures with interventional cardiologists are part of the armamentarium and may be appealing for the present and near future. Despite the nature of demanding procedures and longer learning curve with increased cardiopulmonary bypass times, the outcomes are comparable with same quality as conventional open surgery. Patient recovery is the ultimate purpose of these approaches.
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Affiliation(s)
- Ricardo Boix-Garibo
- Department of Cardiothoracic Surgery, St Thomas' Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | | | - Vinayak Nilkanth Bapat
- Department of Cardiothoracic Surgery, St Thomas' Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK
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