1
|
Ho YL, Khamis AY, Abdul Kareem BA. Left anterior mini-thoracotomy: an alternative approach for pulmonary valve replacement after surgically corrected tetralogy of fallot. J Cardiothorac Surg 2024; 19:427. [PMID: 38982433 PMCID: PMC11234653 DOI: 10.1186/s13019-024-02817-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 05/25/2024] [Indexed: 07/11/2024] Open
Abstract
INTRODUCTION Pulmonary regurgitation (PR) remains a common sequela in patients following surgically corrected TOF, and may lead to progressive right ventricle dilatation and dysfunction. The conventional approach of redo-sternotomy for pulmonary valve replacement (PVR) is associated with increased operative time as well as risks of bleeding and injury to the heart and great vessels. Thus, left anterior mini-thoracotomy has become an alternative approach in eliminating the risks of redo-sternotomy in these patients. This series aimed to determine the outcomes of minimally invasive pulmonary valve replacement after surgical TOF correction. METHODS A retrospective analysis was conducted on 24 patients with severe PR post-surgical TOF correction who underwent left anterior mini-thoracotomy PVR in Penang General Hospital from January 2021 to January 2023. RESULTS The median age was 23.5 years (I.Q.range 17.6-36.3), with a male:female ratio of 1:4. Majority of patients had mild to moderate symptoms prior to surgery and 19 patients (79.1%) were on regular diuretics medication. All patients had severe free-flow PR with evidence of right ventricular dilatation and dysfunction. Magnetic Resonance Imaging and computed tomography of pulmonary artery were performed prior to surgery. Minimally invasive PVR was performed on all patients via left upper anterior mini-thoracotomy and femoral-femoral bypass without cardioplegic arrest. The operative time and cardiopulmonary bypass time were 208 (I.Q.range 172-324) and 98.6 minutes(I.Q.range 87.4-152.4) respectively. The time to wean off inotropes postoperatively was 6.2 hours (I.Q.range1.4-14.8), and no postoperative arrhythmia and chest re-exploration were reported. Most patients stayed in Intensive Care Unit (ICU) for 10.8 hours (I.Q.range 8.4-36.5), and the total hospital stay was 4.2 days (I.Q.range 3.4-7.6). 2 patients (11.1%) required blood transfusion postoperative. There was no paravalvular leak and no mortality during the follow-up period of up to 28 months. CONCLUSION Minimally invasive PVR after surgical correction of TOF is a safe alternative to the conventional redo-sternotomy approach in patients with favorable anatomy. This approach is able to reduce the risks associated with redo-sternotomy, particularly bleeding and injury to mediastinal structures, with the additional benefit of expedited recovery and hospital discharge. Our series has shown a safe and efficient approach in these patients with favorable outcomes.
Collapse
Affiliation(s)
- Yan Le Ho
- Department of Cardiothoracic Surgery, Penang General Hospital, George Town, Penang, Malaysia.
| | - Abu Yamin Khamis
- Department of Cardiothoracic Surgery, Penang General Hospital, George Town, Penang, Malaysia
| | | |
Collapse
|
2
|
Leviner DB, Ronai T, Abraham D, Eliad H, Schwartz N, Sharoni E. Minimal Learning Curve for Minimally Invasive Aortic Valve Replacement. Thorac Cardiovasc Surg 2024. [PMID: 38830605 DOI: 10.1055/a-2337-1978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
BACKGROUND Minimally invasive aortic valve replacement (MiAVR) is an established technique for surgical aortic valve replacement (AVR). Although MiAVR was first described in 1993 and has shown good results compared with full sternotomy AVR (FSAVR) only a minority of patients undergo MiAVR. We recently started using MiAVR via an upper hemisternotomy. We aimed to examine the early results of our initial experience with this technique. METHODS We compared 55 MiAVR patients with a historical cohort of 142 isolated FSAVR patients (December 2016-December 2022). The primary outcome was in-hospital mortality. Secondary outcomes included cardiopulmonary bypass (CPB) and cross-clamp times, blood product intake, in-hospital morbidity, and length of intensive care unit and hospital stay. RESULTS There was no significant difference in preoperative characteristics, including age, laboratory values, and comorbidities. There was no significant difference between the groups regarding in-hospital mortality (FSAVR 3.52 vs. MiAVR 1.82%). There was no significant difference in CPB time (FSAVR 103.5 [interquartile range: 82-119.5] vs. MiAVR 107 min [92.5-120]), aortic cross-clamp time (FSAVR 81 [66-92] vs. MiAVR 90 min [73-99]), and valve size (FSAVR 23 [21-25] vs. MiAVR 23 [21-25]). The incidence of intraoperative blood products transfusion was significantly lower in the MiAVR group (10.91%) compared with the FSAVR group (25.35%, p = 0.03). CONCLUSION Our findings further establish the possibility of reducing invasiveness of AVR without compromising patient safety and clinical outcomes. This is true even in the learning curve period and without requiring any significant change in the operative technique and dedicated equipment.
Collapse
Affiliation(s)
- Dror B Leviner
- Department of Cardiothoracic Surgery, Carmel Medical Center Cardiovascular Center, Haifa, Israel
- Technion Israel Institute of Technology, Haifa, Haifa, Israel
| | - Tom Ronai
- Technion Israel Institute of Technology, Haifa, Haifa, Israel
| | - Dana Abraham
- Technion Israel Institute of Technology, Haifa, Haifa, Israel
| | - Hadar Eliad
- Department of Cardiothoracic Surgery, Carmel Medical Center Cardiovascular Center, Haifa, Israel
| | - Naama Schwartz
- Carmel Medical Center, Research Authority, Haifa, Haifa, Israel
| | - Erez Sharoni
- Department of Cardiothoracic Surgery, Carmel Medical Center Cardiovascular Center, Haifa, Israel
- Technion Israel Institute of Technology, Haifa, Haifa, Israel
| |
Collapse
|
3
|
Sef D, Thet MS, Klokocovnik T, Luthra S. Early and mid-term outcomes after aortic valve replacement using a novel tissue bioprosthesis: a systematic review. Eur J Cardiothorac Surg 2024; 65:ezae045. [PMID: 38331412 DOI: 10.1093/ejcts/ezae045] [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: 12/02/2023] [Revised: 01/14/2024] [Accepted: 02/05/2024] [Indexed: 02/10/2024] Open
Abstract
OBJECTIVES While current data show a clear trend towards the use of bioprosthetic valves during aortic valve replacement (AVR), durability of bioprosthetic valves remains the most important concern. We conducted a 1st systematic review of all available evidence that analysed early and mid-term outcomes after AVR using the Inspiris RESILIA™ bioprosthesis. METHODS A systematic literature search was performed to identify all relevant studies evaluating early and mid-term outcomes after AVR using the Inspiris RESILIA bioprosthesis and including at least 20 patients with no restriction on the publication date. Subgroup meta-analysis was performed to compare Inspiris RESILIA and PERIMOUNT Magna Ease bioprosthesis and to pool the early postoperative mortality and stroke rates. RESULTS A total of 416 studies were identified, of which 15 studies met the eligibility criteria. The studies included a total of 3202 patients with an average follow-up of up to 5.3 years. The average age of patients across the studies was 52.2-75.1 years. Isolated AVR was performed in 39.0-86.4% of patients. In-hospital or 30-day postoperative mortality was 0-2.8%. At the mid-term follow-up, freedom from all-cause mortality was up to 85.4%. Among studies with mid-term follow-up, trace/mild paravalvular leak was detected in 0-3.0%, while major paravalvular leak was found only in up to 2.0% of patients. No statistically significant differences in terms of mortality (P = 0.98, odds ratio 1.02, 95% confidence interval 0.36-2.83) and stroke (P = 0.98, odds ratio 1.01, 95% confidence interval 0.38-2.73) between the Inspiris RESILIA bioprosthesis and PERIMOUNT Magna Ease bioprosthesis were observed in the subgroup meta-analysis. CONCLUSIONS Mid-term data on the safety and haemodynamic performance of the novel aortic bioprosthesis are encouraging. Further comparative studies with other bioprostheses and longer follow-up are still required to endorse durability and safety of the novel bioprosthesis.
Collapse
Affiliation(s)
- Davorin Sef
- Department of Cardiac Surgery, University Hospitals of Leicester, Leicester, UK
| | - Myat Soe Thet
- Faculty of Medicine, Department of Surgery and Cancer, Imperial College London & Imperial College Healthcare NHS Trust, London, UK
| | | | - Suvitesh Luthra
- Department of Cardiac Surgery, Wessex Cardiothoracic Centre, University Hospital of Southampton, Southampton, UK
| |
Collapse
|
4
|
Ilcheva L, Risteski P, Tudorache I, Häussler A, Papadopoulos N, Odavic D, Rodriguez Cetina Biefer H, Dzemali O. Beyond Conventional Operations: Embracing the Era of Contemporary Minimally Invasive Cardiac Surgery. J Clin Med 2023; 12:7210. [PMID: 38068262 PMCID: PMC10707549 DOI: 10.3390/jcm12237210] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 11/18/2023] [Accepted: 11/18/2023] [Indexed: 06/26/2024] Open
Abstract
Over the past two decades, minimally invasive cardiac surgery (MICS) has gained a significant place due to the emergence of innovative tools and improvements in surgical techniques, offering comparable efficacy and safety to traditional surgical methods. This review provides an overview of the history of MICS, its current state, and its prospects and highlights its advantages and limitations. Additionally, we highlight the growing trends and potential pathways for the expansion of MICS, underscoring the crucial role of technological advancements in shaping the future of this field. Recognizing the challenges, we strive to pave the way for further breakthroughs in minimally invasive cardiac procedures.
Collapse
Affiliation(s)
- Lilly Ilcheva
- Department of Cardiac Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.I.); (P.R.); (I.T.); (A.H.); (N.P.); (D.O.); (H.R.C.B.)
| | - Petar Risteski
- Department of Cardiac Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.I.); (P.R.); (I.T.); (A.H.); (N.P.); (D.O.); (H.R.C.B.)
- Department of Cardiac Surgery, Zurich City Hospital—Triemli, 8055 Zurich, Switzerland
| | - Igor Tudorache
- Department of Cardiac Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.I.); (P.R.); (I.T.); (A.H.); (N.P.); (D.O.); (H.R.C.B.)
- Department of Cardiac Surgery, Zurich City Hospital—Triemli, 8055 Zurich, Switzerland
| | - Achim Häussler
- Department of Cardiac Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.I.); (P.R.); (I.T.); (A.H.); (N.P.); (D.O.); (H.R.C.B.)
- Department of Cardiac Surgery, Zurich City Hospital—Triemli, 8055 Zurich, Switzerland
| | - Nestoras Papadopoulos
- Department of Cardiac Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.I.); (P.R.); (I.T.); (A.H.); (N.P.); (D.O.); (H.R.C.B.)
- Department of Cardiac Surgery, Zurich City Hospital—Triemli, 8055 Zurich, Switzerland
| | - Dragan Odavic
- Department of Cardiac Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.I.); (P.R.); (I.T.); (A.H.); (N.P.); (D.O.); (H.R.C.B.)
- Department of Cardiac Surgery, Zurich City Hospital—Triemli, 8055 Zurich, Switzerland
| | - Hector Rodriguez Cetina Biefer
- Department of Cardiac Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.I.); (P.R.); (I.T.); (A.H.); (N.P.); (D.O.); (H.R.C.B.)
- Department of Cardiac Surgery, Zurich City Hospital—Triemli, 8055 Zurich, Switzerland
| | - Omer Dzemali
- Department of Cardiac Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.I.); (P.R.); (I.T.); (A.H.); (N.P.); (D.O.); (H.R.C.B.)
- Department of Cardiac Surgery, Zurich City Hospital—Triemli, 8055 Zurich, Switzerland
| |
Collapse
|
5
|
Gerfer S, Eghbalzadeh K, Brinkschröder S, Djordjevic I, Rustenbach C, Rahmanian P, Mader N, Kuhn E, Wahlers T. Is It Reasonable to Perform Isolated SAVR by Residents in the TAVI Era? Thorac Cardiovasc Surg 2023; 71:376-386. [PMID: 34808679 DOI: 10.1055/s-0041-1736206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The role of conventional surgical aortic valve replacement (SAVR) is increasingly questioned since the indication for transcatheter aortic valve implantations (TAVIs) is currently extended. While the number of patients referred to SAVR decreases, it is unclear if SAVR should be performed by junior resident surgeons in the course of a heart surgeons training. METHODS Patients with isolated aortic valve replacement (AVR) were analyzed with respect to the surgeon's qualification. AVR performed by resident surgeons was compared with AVR by senior surgeons. The collective was analyzed with respect to clinical short-term outcomes comparing full sternotomy (FS) with minimally invasive surgery and ministernotomy (MS) with right anterior thoracotomy (RAT) after a 1:1 propensity score matching. RESULTS The 30-day all-cause mortality was 2.3 and 3.4% for resident versus senior AVR groups, cerebrovascular event rates were 1.1 versus 2.6%, and no cases of significant paravalvular leak were detected. Clinical short-term outcomes between FS and minimally invasive access, as well after MS and RAT were comparable. CONCLUSION Our current data show feasibility and safety of conventional SAVR procedure performed by resident surgeons in the era of TAVI. Minimally invasive surgery should be trained and performed in higher volumes early in the educational process as it is a safe treatment option.
Collapse
Affiliation(s)
- Stephen Gerfer
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Kaveh Eghbalzadeh
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Sarah Brinkschröder
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Ilija Djordjevic
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Christian Rustenbach
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Parwis Rahmanian
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Navid Mader
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Elmar Kuhn
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany
| |
Collapse
|
6
|
Gaisendrees C, Schlachtenberger G, Walter S, Gerfer S, Djordjevic I, Krasivskyi I, Cagman B, Weber C, Jaeger D, Kosmopoulos M, Luehr M, Mader N, Wahlers T. Long-term outcomes after minimal right lateral thoracotomy for the resection of cardiac tumors. Surg Oncol 2023; 49:101952. [PMID: 37285759 DOI: 10.1016/j.suronc.2023.101952] [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: 02/08/2023] [Revised: 03/15/2023] [Accepted: 05/15/2023] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Cardiac tumors are a rare and heterogeneous entity, with a cumulative incidence of up to 0.02%. This study aimed to investigate one of the largest patient cohorts for long-term outcomes after minimally-invasive cardiac surgery using right-anterior thoracotomy and femoral cardiopulmonary bypass (CPB) cannulation. METHODS Between 2009 and 2021, patients who underwent minimally-invasive cardiac tumor removal at our department were included. The diagnosis was confirmed postoperatively by (immune-) histopathological analysis. Preoperative baseline characteristics, intraoperative data, and long-term survival were analyzed. RESULTS Between 2009 and 2021, 183 consecutive patients underwent surgery for a cardiac tumor at our department. Of these, n = 74 (40%) were operated on using a minimally-invasive approach. The majority, n = 73 (98.6%), had a benign cardiac tumor, and 1 (1.4%) had a malignant cardiac tumor. The mean age was 60 ± 14 years, and n = 45 (61%) of patients were female. The largest group of tumors was myxoma (n = 62; 84%). Tumors were predominantly located in the left atrium in 89% (n = 66). CPB-time was 97 ± 36min and aortic cross-clamp time 43 ± 24 min s. The mean hospital stay was 9.7 ± 4.5 days. The perioperative mortality was 0%, and all-cause mortality after ten years was 4.1%. CONCLUSION Minimally-invasive tumor excision is feasible and safe, predominantly in benign cardiac tumors, even in combination with concurrent procedures. Patients who require cardiac tumor removal should be evaluated for minimally-invasive cardiac surgery at a specialized center, as it is highly effective and associated with good long-term survival.
Collapse
Affiliation(s)
- Christopher Gaisendrees
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany.
| | - Georg Schlachtenberger
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Sebastian Walter
- University Hospital Cologne, Department of Orthopaedics, Cologne, Germany
| | - Stephen Gerfer
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Ilija Djordjevic
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Ihor Krasivskyi
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Burak Cagman
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Carolyn Weber
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Deborah Jaeger
- Emergency Department, University Hospital of Nancy, Nancy, France
| | - Marinos Kosmopoulos
- Center for Resuscitation Medicine, University of Minnesota, Minneapolis, USA
| | - Maximilian Luehr
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Navid Mader
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Thorsten Wahlers
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany
| |
Collapse
|
7
|
Kulacoglu UK, Kaya M. Ministernotomy in Aortic Root and Arch Surgery: Early Outcomes. Braz J Cardiovasc Surg 2023; 38:15-21. [PMID: 36112739 PMCID: PMC10010722 DOI: 10.21470/1678-9741-2021-0372] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
Abstract
INTRODUCTION Minimally invasive methods have become more preferred in cardiac surgery today. In this study, the comparative results of patients who underwent an aortic root, arch or hemiarch replacement by ministernotomy and full sternotomy in our clinic are presented. METHODS Between January 2017 and October 2019, a series of operations including aortic root, ascending aorta, and aortic arch replacements were performed on 278 patients. The ministernotomy technique was used in 25 of them. Twenty patients who underwent full sternotomy were selected and matched to this group for comparison. RESULTS The ministernotomy group had a longer cross-clamping time (128.3±30.8 vs. 104.7±23.4 min, P=0.007) but the total operating time was similar in the two groups (249.76±28.56 vs. 248.25±37.53 min, P=0.879). The number of red blood cell (RBC) transfusions per patient was higher in the full sternotomy group (4.65±3.74 vs. 2.44±1.85 unit, P=0.020). The ministernotomy group had shorter ventilation times (7.60±4.88 vs. 32.30±32.25 h, P<0.001) and shorter ICU stay (1.56±0.58 vs. 3.35±1.46 d, P<0.001). The 30-day mortality was 0% in the ministernotomy group. CONCLUSION Early results of our study show that, in combined or isolated aortic root, ascending aorta, and aortic arch surgeries, ministernotomy can be applied with relatively safety and low mortality and morbidity rates.
Collapse
Affiliation(s)
- Ulku Kafa Kulacoglu
- Department of Cardiovascular Surgery, Republic of Turkey Ministry of Health, University of Health Sciences Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital
| | - Mehmet Kaya
- Department of Cardiovascular Surgery, Republic of Turkey Ministry of Health, University of Health Sciences Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital
| |
Collapse
|
8
|
Jovanovic M, Zivkovic I, Jovanovic M, Bilbija I, Petrovic M, Markovic J, Radovic I, Dimitrijevic A, Soldatovic I. Economic Justification Analysis of Minimally Invasive versus Conventional Aortic Valve Replacement. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2553. [PMID: 36767915 PMCID: PMC9916198 DOI: 10.3390/ijerph20032553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/27/2023] [Accepted: 01/29/2023] [Indexed: 06/18/2023]
Abstract
There is no definitive consensus about the cost-effectiveness of minimally invasive aortic valve replacement (AVR) (MI-AVR) compared to conventional AVR (C-AVR). The aim of this study was to compare the rate of postoperative complications and total hospital costs of MI-AVR versus C-AVR overall and by the type of aortic prosthesis (biological or mechanical). Our single-center retrospective study included 324 patients over 18 years old who underwent elective isolated primary AVR with standard stented AV prosthesis at the Institute for Cardiovascular Diseases "Dedinje" between January 2019 and December 2019. Reintervention, emergencies, combined surgical interventions, and patients with sutureless valves were excluded. In both MI-AVR and C-AVR, mechanical valve implantation contributed to overall reduction of hospital costs with equal efficacy. The cost-effectiveness ratio indicated that C-AVR is cheaper and yielded a better clinical outcome with mechanical valve implantation (67.17 vs. 69.5). In biological valve implantation, MI-AVR was superior. MI-AVR patients had statistically significantly higher LVEF and a lower Euro SCORE than C-AVR patients (Mann-Whitney U-test, p = 0.002 and p = 0.002, respectively). There is a slight advantage to MI-AVR vs. C-AVR, since it costs EUR 9.44 more to address complications that may arise. Complications (mortality, early reoperation, cerebrovascular insult, pacemaker implantation, atrial fibrillation, AV block, systemic inflammatory response syndrome, wound infection) were less frequent in the MI-AVR, making MI-AVR more economically justified than C-AVR (18% vs. 22.1%).
Collapse
Affiliation(s)
- Marko Jovanovic
- Institute for Cardiovascular Diseases “Dedinje”, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Igor Zivkovic
- Institute for Cardiovascular Diseases “Dedinje”, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Milos Jovanovic
- Institute for Cardiovascular Diseases “Dedinje”, 11000 Belgrade, Serbia
| | - Ilija Bilbija
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Cardiac Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Masa Petrovic
- Institute for Cardiovascular Diseases “Dedinje”, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Jovan Markovic
- Faculty of Dental Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Ivana Radovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Transfusiology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Ana Dimitrijevic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Ivan Soldatovic
- Institute of Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| |
Collapse
|
9
|
Strobel RJ, Hawkins RB, Mehaffey JH, Rotar EP, Yount KW, Teman NR, Ailawadi G. Minimally Invasive Approaches Are Safe for Concomitant Mitral and Tricuspid Valve Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2022; 17:416-423. [DOI: 10.1177/15569845221128297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: The need for concomitant tricuspid surgery during mitral valve surgery is associated with higher operative risk. We hypothesized that concomitant tricuspid surgery through a minimally invasive thoracotomy (MICS) is associated with noninferior risk compared with a sternotomy. Methods: All patients undergoing mitral valve surgery at a single institution (2010 to 2020) were evaluated. After excluding endocarditis, emergent operations, and concomitant aortic valve or coronary artery bypass grafting procedures, patients were stratified by MICS versus sternotomy. Multivariable logistic regression assessed the risk-adjusted association between concomitant tricuspid valve procedure and Society of Thoracic Surgeons major morbidity or mortality. An interaction term evaluated the impact of approach on concomitant tricuspid surgery. Results: A total of 772 patients underwent mitral valve surgery, including 138 (17.9%) with concomitant tricuspid valve operation. Of the total cohort, 243 patients (31.5%) underwent the MICS approach. Concomitant tricuspid operation was performed in 104 sternotomy patients (19.7%) compared with 34 MICS patients (14.0%, P = 0.056). After risk adjustment, patients who underwent concomitant tricuspid valve surgery via sternotomy had nearly 2 times greater odds of morbidity and mortality relative to those undergoing isolated mitral surgery via sternotomy (adjOR = 1.86, P = 0.049), while patients who underwent concomitant tricuspid surgery via the MICS approach had no increased risk of the composite outcome (adjOR = 0.66, P = 0.543), relative to isolated mitral surgery via MICS approach. Conclusions: Concomitant tricuspid surgery at the time of mitral valve surgery carries additional risk in a broad patient population. A minimally invasive approach appears to be safe for selected patients requiring concomitant tricuspid valve surgery.
Collapse
Affiliation(s)
- Raymond J. Strobel
- Division of Cardiac Surgery, University of Virginia, Charlottesville, VA, USA
| | - Robert B. Hawkins
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, USA
| | - J. Hunter Mehaffey
- Division of Cardiac Surgery, University of Virginia, Charlottesville, VA, USA
| | - Evan P. Rotar
- Division of Cardiac Surgery, University of Virginia, Charlottesville, VA, USA
| | - Kenan W. Yount
- Division of Cardiac Surgery, University of Virginia, Charlottesville, VA, USA
| | - Nicholas R. Teman
- Division of Cardiac Surgery, University of Virginia, Charlottesville, VA, USA
| | - Gorav Ailawadi
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
10
|
Left Ventricular Assist Device Implantation via Lateral Thoracotomy: A Systematic Review and Meta-Analysis. J Heart Lung Transplant 2022; 41:1440-1458. [DOI: 10.1016/j.healun.2022.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 06/25/2022] [Accepted: 07/06/2022] [Indexed: 12/29/2022] Open
|
11
|
Seguel E. Cirugía cardíaca en ancianos: riesgo operatorio y alternativas de tratamiento. REVISTA MÉDICA CLÍNICA LAS CONDES 2022. [DOI: 10.1016/j.rmclc.2022.04.004] [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] Open
|
12
|
Wilson TW, Horns JJ, Sharma V, Goodwin ML, Kagawa H, Pereira SJ, McKellar SH, Selzman CH, Glotzbach JP. Minimally Invasive versus Full Sternotomy SAVR in the Era of TAVR: An Institutional Review. J Clin Med 2022; 11:jcm11030547. [PMID: 35159998 PMCID: PMC8836475 DOI: 10.3390/jcm11030547] [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: 11/30/2021] [Revised: 01/04/2022] [Accepted: 01/19/2022] [Indexed: 02/01/2023] Open
Abstract
In the era of advancing transcatheter aortic valve replacement (TAVR) technology, traditional open surgery remains a valuable intervention for patients who are not TAVR candidates. We sought to compare perioperative variables and postoperative outcomes of minimally invasive and full sternotomy surgical aortic valve replacement (SAVR) at a single institution. A retrospective analysis of 113 patients who underwent isolated SAVR via full sternotomy or upper hemi-sternotomy between January 2015 and December 2019 at the University of Utah Hospital was performed. Preoperative comorbidities and demographic information were not different among groups, with the exception of diabetes, which was significantly more common in the full sternotomy group (p = 0.01). Median procedure length was numerically shorter in the minimally invasive group but was not significant following the Bonferroni correction (p = 0.047). Other perioperative variables were not significantly different. The two groups showed no difference in the incidence of postoperative adverse events (p = 0.879). As such, minimally invasive SAVR via hemi-sternotomy remains a safe and effective alternative to full sternotomy for patients who meet the criteria for aortic valve replacement.
Collapse
Affiliation(s)
- Tyler W. Wilson
- School of Medicine, University of Utah, Salt Lake City, UT 84132, USA;
| | - Joshua J. Horns
- Department of Surgery, University of Utah, Salt Lake City, UT 84132, USA;
| | - Vikas Sharma
- Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, UT 84132, USA; (V.S.); (M.L.G.); (H.K.); (S.J.P.); (C.H.S.)
| | - Matthew L. Goodwin
- Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, UT 84132, USA; (V.S.); (M.L.G.); (H.K.); (S.J.P.); (C.H.S.)
| | - Hiroshi Kagawa
- Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, UT 84132, USA; (V.S.); (M.L.G.); (H.K.); (S.J.P.); (C.H.S.)
| | - Sara J. Pereira
- Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, UT 84132, USA; (V.S.); (M.L.G.); (H.K.); (S.J.P.); (C.H.S.)
| | - Stephen H. McKellar
- Cardiovascular and Thoracic Surgery, Intermountain Medical Center Heart Institute, Salt Lake City, UT 84107, USA;
| | - Craig H. Selzman
- Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, UT 84132, USA; (V.S.); (M.L.G.); (H.K.); (S.J.P.); (C.H.S.)
| | - Jason P. Glotzbach
- Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, UT 84132, USA; (V.S.); (M.L.G.); (H.K.); (S.J.P.); (C.H.S.)
- Correspondence:
| |
Collapse
|
13
|
Alkady H, Abouramadan S. A Simple Approach for Minimally Invasive Combined Aortic and Mitral Valve Surgery. Thorac Cardiovasc Surg 2021; 70:120-125. [PMID: 34963177 PMCID: PMC8913047 DOI: 10.1055/s-0041-1740240] [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] [Indexed: 11/02/2022]
Abstract
BACKGROUND There is now extension of minimally invasive techniques to involve concomitantly aortic and mitral valves through a single small incision. We share our experience in such surgeries through upper partial sternotomy with approaching the mitral valve through the dome of the left atrium. METHODS Two matched groups of cases receiving concomitant aortic and mitral valve surgeries are compared regarding the surgical outcomes: the minimally invasive group (group A) including 72 patients and the conventional group (group B) including 78 patients. RESULTS The mean age was 52 ± 8 years in group A and 53 ± 7 years in group B. Males represented (42%) in group A and (49%) in group B. The mean mechanical ventilation time was significantly shorter in group A (4.3 ± 1.2 hours) than in group B (6.1 ± 0.8 hours) with a p-value of 0.001. In addition, the amount of chest tube drainage and the need for blood transfusion units were significantly less in group A (250 ± 160 cm3 and 1.3 ± 0.8 units, respectively) when compared with group B (320 ± 180 cm3 and 1.8 ± 0.9 units, respectively) with p-values of 0.013 and 0.005, respectively. Over a follow-up period of 3.2 ± 1.1 years, one mortality occurred in each group with no significant difference (p-value = 0.512). CONCLUSION Combined aortic and mitral valve surgery through upper partial sternotomy with approaching the mitral valve through the dome of the left atrium is safe and effective with the advantages of less postoperative blood loss, need for blood transfusion, and mechanical ventilation time compared with conventional aortic and mitral valve surgery.
Collapse
Affiliation(s)
- Hesham Alkady
- Department of Cardiothoracic Surgery, Cairo University, Cairo, Egypt
| | - Sobhy Abouramadan
- Department of Cardiothoracic Surgery, Cairo University, Cairo, Egypt
| |
Collapse
|
14
|
De Viti D, Dambruoso P, Izzo P, Dhojniku I, Raimondo P, Carbone C, Paparella D. Iatrogenic Acute Aortic Dissection in the Era of Minimally Invasive Cardiac Surgery - Experience of a Center and Review of Literature. Braz J Cardiovasc Surg 2021; 36:691-699. [PMID: 34787991 PMCID: PMC8597616 DOI: 10.21470/1678-9741-2020-0561] [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] [Indexed: 11/08/2022] Open
Abstract
Introduction Iatrogenic acute aortic dissection (IAAD) type A is a rare but potentially fatal complication of cardiac surgery. Methods The purpose of this article is to review the literature since the first reports of IAAD in 1978, examining its clinical characteristics and describing operative details and surgical outcomes. Moreover, we reviewed the recent literature to identify current trends and risk factors for IAAD in minimally invasive cardiac surgery procedures, often related to femoral artery cannulation for retrograde perfusion. Results We found that IAAD ranges from 0.04 to 0.29% of cardiac patients in overall trials and ranged from 0.12 to 0.16% between 1978-1990, before the minimally invasive surgical era. And we concluded that since the first cases to the recent reports, the incidence of IAAD has not significantly changed. As minimally invasive procedures are on the rise, some authors think that the incidence of IAAD could increase in the future; we think that using all the precaution - such a strict monitoring of perfusion pressure throughout the intervention, avoiding extremely high jet pressures using vasodilators, repositioning of arterial cannula, or splitting perfusion in both femoral arteries -, this complication can be extremely reduced. Finally, we describe a very singular case occurring during mitral valve replacement followed by spontaneous dissection of left anterior descending artery one month later. Conclusion The present article adds to the literature a more detailed clinical picture of this entity, including patients' characteristics, the mechanism, timing, and localization of the tear, and mortality details.
Collapse
Affiliation(s)
- Daniele De Viti
- Department of Cardiology, Santa Maria Hospital, GVM Care and Research, Bari, Italy
| | - Pierpaolo Dambruoso
- Department of Cardiac Anesthesia and Intensive Care, Santa Maria Hospital, GVM Care and Research, Bari, Italy
| | - Paolo Izzo
- Department of Cardiology, Santa Maria Hospital, GVM Care and Research, Bari, Italy
| | - Ilir Dhojniku
- Department of Cardiac Anesthesia and Intensive Care, Santa Maria Hospital, GVM Care and Research, Bari, Italy
| | - Pasquale Raimondo
- Department of Emergency and Organ Transplant, University of Bari "Aldo Moro", Bari, Italy
| | - Carmine Carbone
- Department of Cardiac Surgery, Santa Maria Hospital, GVM Care and Research, Bari, Italy
| | - Domenico Paparella
- Department of Cardiac Surgery, Santa Maria Hospital, GVM Care and Research, Bari, Italy.,Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| |
Collapse
|
15
|
Torky MA, Arafat AA, Fawzy HF, Taha AM, Wahby EA, Herijgers P. J-ministernotomy for aortic valve replacement: a retrospective cohort study. THE CARDIOTHORACIC SURGEON 2021. [DOI: 10.1186/s43057-021-00050-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The advantage of minimally invasive sternotomy (MS) over full sternotomy (FS) for isolated aortic valve replacement (AVR) is still controversial. We aimed to examine if J-shaped MS is a safe alternative to FS in patients undergoing primary isolated AVR. This study is a retrospective and restricted cohort study that included 137 patients who had primary isolated AVR from February 2013 to June 2015. Patients with previous cardiac operations, low ejection fraction (< 40%), infective endocarditis, EuroSCORE II predicted mortality > 10%, and patients who had inverted T or inverted C-MS or right anterior thoracotomy were excluded. Patients were grouped into the FS group (n=65) and MS group (n=72). Preoperative variables were comparable in both groups. The outcome was studied, balancing the groups by propensity score matching.
Results
Seven (9%) patients in the MS group were converted to FS. Cardiopulmonary bypass (98.5 ± 29.3 vs. 82.1 ± 13.95 min; p ≤ 0.001) and ischemic times (69.1 ± 23.8 vs. 59.6 ± 12.2 min; p = 0.001) were longer in MS. The MS group had a shorter duration of mechanical ventilation (10.1 ± 11.58 vs. 10.9 ± 6.43 h; p = 0.045), ICU stay (42.74 ± 40.5 vs. 44.9 ± 39.3; p = 0.01), less chest tube drainage (385.3 ± 248.6 vs. 635.9 ± 409.6 ml; p = 0.001), and lower narcotics use (25.14 ± 17.84 vs. 48.23 ± 125.68 mg; p < 0.001). No difference was found in postoperative heart block with permanent pacemaker insertion or atrial fibrillation between groups (p = 0.16 and 0.226, respectively). Stroke, renal failure, and mortality did not differ between the groups. Reintervention-free survival at 1, 3, and 4 years was not significantly different in both groups (p = 0.73).
Conclusion
J-ministernotomy could be a safe alternative to FS in isolated primary AVR. Besides the cosmetic advantage, it could have better clinical outcomes without added risk.
Collapse
|
16
|
Abstract
Primary cardiac tumours for which surgical resection is the main stay of treatment are rare and present both diagnostic and management challenges. The majority of patients are asymptomatic and one third of those who have symptoms present with vague constitutional symptoms which further complicates the process of early diagnosis. The current state-of-the art multi-modality imaging, routine use of intra-operative transoesophageal echocardiogram (TOE) in most cardiac centres and the tremendous advances of endoscopic adjuncts greatly enhances both the diagnosis and management of those group of patients. The surgical burden of median sternotomy and the contemporary trend towards less invasive surgery urged the necessity for adopting minimally invasive surgery in general and cardiac tumours are no exception. Despite the rarity of theses tumours, minimally invasive resection is successful in the hands of experienced minimally invasive surgeons who employ the same minimal access valve surgery platform to access the tumours in various cardiac chambers and valves with no compromise to the oncological clearance and hence achieve the benefits of minimally invasive surgery without compromising long term outcomes.
Collapse
Affiliation(s)
- Ayman Kenawy
- Department of Cardiothoracic Surgery, Lancashire Heart Centre, Blackpool Teaching Hospital, Blackpool, UK
| | - Abdelrahman Abdelbar
- Department of Cardiothoracic Surgery, Lancashire Heart Centre, Blackpool Teaching Hospital, Blackpool, UK
| | - Joseph Zacharias
- Department of Cardiothoracic Surgery, Lancashire Heart Centre, Blackpool Teaching Hospital, Blackpool, UK
| |
Collapse
|
17
|
Abstract
Since their introduction, it has been demonstrated that minimally invasive aortic valve replacement (MIAVR) approaches are safe and effective for the treatment of aortic valve diseases. To date, the main advantage of these approaches is represented by the reduced surgical trauma, with a subsequent reduced complication rate and faster recovery. This makes such approaches an appealing choice also for frail patients [obese, aged, chronic obstructive pulmonary disease (COPD)]. The standardization of the minimally invasive techniques, together with the implementation of preoperative workup and anesthesiological intra- and post-operative care, led to an amelioration of surgical results and reduction of surgical times. Moreover, the improvement of surgical technology and the introduction of new devices such as sutureless and rapid deployment (SURD) valves, has helped the achievement of comparable results to traditional surgery. However, transcatheter technologies are nowadays more and more important in the treatment of aortic valve disease, also in low risk patients. For this reason surgeons should put new efforts for further reducing the surgical trauma in the future, even taking inspiration from other disciplines. In this review, we aim to present a review of literature evidences regarding minimally invasive treatment of aortic diseases, also reflecting our personal experience with MIAVR techniques. This review could represent a tool for a well-structured patient assessment and preoperative planning, in order to safely carrying out an MIAVR procedure with satisfactory outcomes.
Collapse
Affiliation(s)
- Lorenzo Di Bacco
- U.O. Cardiochirurgia Mininvasiva, Istituto Clinico Sant'Ambrogio, Gruppo San Donato, Milano, Italy
| | - Antonio Miceli
- U.O. Cardiochirurgia Mininvasiva, Istituto Clinico Sant'Ambrogio, Gruppo San Donato, Milano, Italy
| | - Mattia Glauber
- U.O. Cardiochirurgia Mininvasiva, Istituto Clinico Sant'Ambrogio, Gruppo San Donato, Milano, Italy
| |
Collapse
|
18
|
Sef D, Krajnc M, Klokocovnik T. Minimally invasive aortic valve replacement with sutureless bioprosthesis through right minithoracotomy with completely central cannulation-Early results in 203 patients. J Card Surg 2020; 36:558-564. [PMID: 33314301 DOI: 10.1111/jocs.15257] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/18/2020] [Accepted: 12/03/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Minimally invasive aortic valve replacement (mini-AVR) might improve clinical outcomes, particularly in high-risk and elderly patients. Sutureless/rapid deployment bioprosthesis can offer advantage of decreasing the cross-clamp time (XCT) and easing the procedure. Our aim was to evaluate the safety and perioperative outcomes of mini-AVR using sutureless bioprothesis via the right minithoracotomy approach with our modified technique of central cannulation. METHODS We performed a single-center retrospective analysis of 203 patients consecutively undergoing isolated AVR between March 2016 and June 2018 with the right minithoracotomy approach and our modified technique of central cannulation. Aortic valve diseases were stenosis (89.9%), regurgitation (1.6%), and mixed valve disease (8.5%). Patients with concomitant procedures were excluded. Primary endpoints were 30-day and 4-month mortality. RESULTS Mean age was 76 ± 6.2 years, 63 (31%) patients were 80 years or older. Cardiopulmonary bypass and XCT were 60.5 (39-153) and 35 (24-76) min, respectively. Thirty-day and 4-month mortality were 1% (two patients). We have observed minor paravalvular leak (PVL) which occurred in seven patients (3.4%), and no moderate/severe PVL was found perioperatively. One patient developed moderate/severe PVL during the 4-month follow-up. There was no structural valve degeneration. Two (1%) patients needed conversion to full sternotomy, and two (1%) patients to ministernotomy. CONCLUSIONS Mini-AVR via the right minithoracotomy approach with central cannulation is an effective and safe procedure and demonstrates excellent early clinical outcomes. This approach can be particularly valuable in higher risk and elderly patients.
Collapse
Affiliation(s)
- Davorin Sef
- Department of Cardiothoracic Surgery and Transplant Unit, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, London, UK
| | - Martina Krajnc
- Department of Cardiovascular Surgery, University Hospital Centre Ljubljana, Ljubljana, Slovenia
| | - Tomislav Klokocovnik
- Department of Cardiovascular Surgery, University Hospital Centre Ljubljana, Ljubljana, Slovenia
| |
Collapse
|
19
|
Cortez-Vega R, Chairez I, Luviano-Juarez A, Lozada-Castillo N, Feliu-Batlle V. Multi-link endoscopic manipulator robot actuated by shape memory alloys spring actuators controlled by a sliding mode. ISA TRANSACTIONS 2020:S0019-0578(20)30456-0. [PMID: 33213885 DOI: 10.1016/j.isatra.2020.10.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 06/27/2020] [Accepted: 10/20/2020] [Indexed: 06/11/2023]
Abstract
The aim of this study was to design and evaluate a prototype of a snake-like endoscopic manipulator robot (SLEMR) and its corresponding automatic controller based on the first order sliding mode theory. The SLEMR was controlled with a set of actuators made of shape memory alloys (SMA). The SLEMR device was constructed with a sequential arrangement of links interconnected by a two degree-of-freedom joint. A parallel agonist-antagonist configuration of actuators was implemented to move each joint. The physical relation between temperature and elongation in SMA forced the execution of the movement in the joint. Elongation-temperature model of the SMA actuator served to get a feasible bound of velocity for each joint. Each pair of SMA actuators was controlled by a first order sliding mode controller. This control design solved the tracking trajectory problem for each joint in the SLEMR because of its robustness against uncertainties and external perturbations. The control action was projected into a feasible implementable set of pulse-width modulated signals which was used to regulate the temperature of the corresponding SMA actuator. The controller designed in this study was experimentally validated in a SLEMR made up by a tridimensional printing technique. The control strategy induced the successful trajectory tracking for all the joints in the SLEMR simultaneously. This characteristic of the control design also enforces the tracking of a reference position by the tip of the final link of the SLEMR. An image acquisition system was used to determine the position of the final actuator in the SLEMR. The effectiveness of the controller proposed in this study was confirmed by the evaluation of the tracking error of the final actuator which approached to a bounded region (less than 1.0 mm) near the origin in a finite-time (0.5 s).
Collapse
Affiliation(s)
- R Cortez-Vega
- Instituto Politécnico Nacional - UPIITA, Av. IPN 2580 Col. Barrio la Laguna Ticomán, Ciudad de México, C.P. 07340, Mexico.
| | - I Chairez
- Instituto Politécnico Nacional - UPIBI, Av. Acueducto de Guadalupe S/N, Col. Barrio la Laguna Ticomán, Ciudad de México, C.P. 07340, Mexico; Instituto Tecnologico de Estudios Superiores de Monterrey - Campus Guadalajara, Av. Gral Ramon Corona No 2514, Colonia Nuevo Mexico, Zapopan, Jal., C.P. 45201, Mexico.
| | - A Luviano-Juarez
- Instituto Politécnico Nacional - UPIITA, Av. IPN 2580 Col. Barrio la Laguna Ticomán, Ciudad de México, C.P. 07340, Mexico.
| | - N Lozada-Castillo
- Instituto Politécnico Nacional - UPIITA, Av. IPN 2580 Col. Barrio la Laguna Ticomán, Ciudad de México, C.P. 07340, Mexico.
| | - V Feliu-Batlle
- Department of Electrical, Electronic and Automatic Engineering, Higher Technical School of Industrial Engineering, University of Castilla-La Mancha, Av. Camilo José Cela s/n, 13071 Ciudad Real, Spain.
| |
Collapse
|
20
|
Piarulli A, Chiariello GA, Bruno P, Cammertoni F, Rabini A, Pavone N, Pasquini A, Ferraro F, Mazza A, Nesta M, Iafrancesco M, Colizzi C, Massetti M. Psychological Effects of Skin Incision Size in Minimally Invasive Valve Surgery Patients. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2020; 15:532-540. [DOI: 10.1177/1556984520956980] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Objective Clinical benefits of minimally invasive cardiac valve surgery (MIVS) have been reported. Improved postoperative mental status was never analyzed with dedicated psychological tests. In the present study we intend to investigate potential benefits of MIVS for patient psychological well-being, with special attention to the relevance of the patient perception of the chest surgical scar, of the self body image and cosmetic aspects. Methods Between 2016 and 2017, 87 eligible patients, age 66.5 ± 14.5 years, operated on for heart valve surgery, underwent either conventional full sternotomy (CS; n = 48) or MIVS by V-shape hemi-sternotomy approach ( n = 39). Before selection of the surgical approach, patients had undergone preoperative evaluation of their psychological status using Beck Depression Inventory-II (BDI-II), State-Trait Anxiety Inventory Form Y (STAI-Y), and EuroQol-5D (EQ-5D) psychological tests. Six months postoperatively, patients filled in dedicated questionnaires to assess their psychological status, quality of life, and subjective perception, thus repeating the above-mentioned tests and adding the Body Image Questionnaire (BIQ) and Patient and Observer Scar Assessment Scale (POSAS) v2.0 tests for scar-healing process evaluation. Results No patient died during the study.The 4 post-test scales of psychological well-being (BDI-II P = 0.04, STAI-Y P = 0.04, 2 indices of EQ-5D P = 0.03, P = 0.01) showed significant differences between the MIVS group and CS group, with MIVS-small incision patients having lower level of depression and anxiety symptoms and better quality of life. Mean score differences of scar perception (BIQ and POSAS v2.0) were significant, with MIVS patients having evaluated the scar quality significantly better than CS patients. Conclusions MIVS appears associated with significant esthetical and related psychological benefits, as documented by technical tests. These findings should be considered when selecting the most appropriate technique for heart valve surgery.
Collapse
Affiliation(s)
- Alessandra Piarulli
- Cardiovascular Sciences Department, Agostino Gemelli Polyclinic Foundation IRCSS, Rome, Italy
- Catholic University of The Sacred Heart, Rome, Italy
| | - Giovanni Alfonso Chiariello
- Cardiovascular Sciences Department, Agostino Gemelli Polyclinic Foundation IRCSS, Rome, Italy
- Catholic University of The Sacred Heart, Rome, Italy
| | - Piergiorgio Bruno
- Cardiovascular Sciences Department, Agostino Gemelli Polyclinic Foundation IRCSS, Rome, Italy
| | - Federico Cammertoni
- Cardiovascular Sciences Department, Agostino Gemelli Polyclinic Foundation IRCSS, Rome, Italy
| | - Alessia Rabini
- Cardiovascular Sciences Department, Agostino Gemelli Polyclinic Foundation IRCSS, Rome, Italy
- Catholic University of The Sacred Heart, Rome, Italy
| | - Natalia Pavone
- Cardiovascular Sciences Department, Agostino Gemelli Polyclinic Foundation IRCSS, Rome, Italy
- Catholic University of The Sacred Heart, Rome, Italy
| | - Annalisa Pasquini
- Cardiovascular Sciences Department, Agostino Gemelli Polyclinic Foundation IRCSS, Rome, Italy
- Catholic University of The Sacred Heart, Rome, Italy
| | - Francesco Ferraro
- Cardiovascular Sciences Department, Agostino Gemelli Polyclinic Foundation IRCSS, Rome, Italy
- Catholic University of The Sacred Heart, Rome, Italy
| | - Andrea Mazza
- Cardiovascular Sciences Department, Agostino Gemelli Polyclinic Foundation IRCSS, Rome, Italy
| | - Marialisa Nesta
- Cardiovascular Sciences Department, Agostino Gemelli Polyclinic Foundation IRCSS, Rome, Italy
- Catholic University of The Sacred Heart, Rome, Italy
| | - Mauro Iafrancesco
- Cardiovascular Sciences Department, Agostino Gemelli Polyclinic Foundation IRCSS, Rome, Italy
| | - Christian Colizzi
- Cardiovascular Sciences Department, Agostino Gemelli Polyclinic Foundation IRCSS, Rome, Italy
- Catholic University of The Sacred Heart, Rome, Italy
| | - Massimo Massetti
- Cardiovascular Sciences Department, Agostino Gemelli Polyclinic Foundation IRCSS, Rome, Italy
- Catholic University of The Sacred Heart, Rome, Italy
| |
Collapse
|
21
|
Charchyan ER, Breshenkov DG, Belov YV. Results of Minimally Invasive Valve-Sparing Aortic Root Valve Surgery: Propensity Score Matching Analysis. ACTA ACUST UNITED AC 2020; 60:91-97. [PMID: 33155946 DOI: 10.18087/cardio.2020.7.n1098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 06/29/2020] [Indexed: 11/18/2022]
Abstract
Aim Evaluation of efficacy and safety of minimally invasive, valve-sparing interventions on the aortic root and a comparative analysis of outcomes versus a group of patients with a complete sternotomy intervention using the method of propensity score matching (PSM).Materials and methods From 2016 through 2019, 458 interventions on the aortic root were performed, including 160 (36.6 %) interventions with mini-sternotomy. The study included 106 patients with the valve-sparing surgery (David procedure). Two groups of 30 patients each were formed using PSMC: group 1, complete sternotomy (CS) and group 2, J-shaped mini-sternotomy (MS). Immediate and long-term outcomes were evaluated at 13.8±10.3 (1-38 months (min-max) in the MS group and 42±21 (1-61 months (min-max) in the CS group.Results Statistically significant differences in death rate, echocardiographic indexes, absence of reoperations and complications in the postoperative period were not observed. In group 2, durations of extracorporeal circulation (p=0.04) and period of myocardial ischemia (p=0.004) were increased. The same group showed decreased intraoperative blood loss (p=0.001), postoperative drainage losses (p=0.0001), extubation time (р=0.0001), duration of stay in resuscitation and intensive care units and in the department of reconstructive recovery cardiovascular surgery (p=0,005).Conclusion The David procedure with mini-sternotomy is a safe and effective alternative to the traditional approach. This technique significantly reduces the time of rehabilitation and duration of patients' stay in the hospital without significant differences in the long-term period, which suggests advantages of this method. However, despite these promising results, the retrospective nature of this study, a small sample of patients, and a short follow-up period warrant further study.
Collapse
Affiliation(s)
- E R Charchyan
- Department of Reconstructive Cardiovascular Surgery, Petrovsky National Research Center of Surgery, Moscow
| | - D G Breshenkov
- Department of Reconstructive Cardiovascular Surgery, Petrovsky National Research Center of Surgery, Moscow
| | - Yu V Belov
- Department of Reconstructive Cardiovascular Surgery, Petrovsky National Research Center of Surgery, Moscow
| |
Collapse
|
22
|
Shneider YA, Tsoi MD, Fomenko MS, Pavlov AA, Shilenko PA. [Aortic valve replacement via J-shaped partial upper sternotomy: randomized trial, mid-term results]. Khirurgiia (Mosk) 2020:25-30. [PMID: 32736460 DOI: 10.17116/hirurgia202007125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the effectiveness and safety of aortic valve replacement through upper partial J-shaped sternotomy compared to conventional sternotomy. MATERIAL AND METHODS There were 240 procedures of isolated aortic valve replacement for the period 2012-2017. According to inclusion criteria, 112 patients were randomized into 2 groups: group I - median sternotomy, group II - upper partial J-shaped sternotomy. Mean age of patients was 56.1±14.3 and 53.1±14.9 years, respectively (p=0.284). Females prevailed in both groups (55.4% vs. 57.1%, p=0.848). Peak pressure gradient on the aortic valve was 106.2±23.9 and 102.8±25.3 mm Hg, respectively (p=0.484). RESULTS In-hospital mortality was 1.8% (n=1) in group I (p=0.315). Incidence of postoperative complications (complete atrioventricular blockade, ventricular septal defect) was similar (p=1.0). Mean time cross clamping in I and II groups was 65.5±12.5 and 64.7±13.1 min (p=0.729). Mean follow-up period was 31.6 and 33.5 months, respectively. Kaplan-Meier survival rate was 92.6 and 93.0%, respectively (log-rank test=0,767). Freedom from thromboembolic events was 91.7 and 90% (log-rank test=0.213). CONCLUSION. U Pper partial J-shaped sternotomy is safe and effective for aortic valve surgery and characterized by similar outcomes compared to conventional sternotomy.
Collapse
Affiliation(s)
- Yu A Shneider
- Federal Center for High Medical Technologies of the Ministry of Health, Kaliningrad, Russia
| | - M D Tsoi
- Federal Center for High Medical Technologies of the Ministry of Health, Kaliningrad, Russia
| | - M S Fomenko
- Federal Center for High Medical Technologies of the Ministry of Health, Kaliningrad, Russia
| | - A A Pavlov
- Federal Center for High Medical Technologies of the Ministry of Health, Kaliningrad, Russia
| | - P A Shilenko
- Federal Center for High Medical Technologies of the Ministry of Health, Kaliningrad, Russia
| |
Collapse
|
23
|
Harky A, Kwok HT, Fan KS. The Evolution of Mitral Valve Surgery: the Future in the Hand of Robots. Braz J Cardiovasc Surg 2020; 35:555-564. [PMID: 32864937 PMCID: PMC7454639 DOI: 10.21470/1678-9741-2019-0192] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Objective To examine the current literature behind the evolution of mitral valve surgery techniques and their impact on patient outcomes. Methods An electronic literature search among major databases was performed (PubMed, Embase, Scopus, Cochrane, and Google scholar). All the relevant articles were screened and identified to be included in this narrative review. The main outcomes were postoperative morbidity, length of in-hospital stay, and long-term mortality. Results Minimally invasive and robot-assisted approach to mitral valve repair and replacements has shown great potential in improving surgical outcomes when compared against traditional midline sternotomy. Selected patients can benefit from percutaneous mitral valve surgery; however, more evidence is required to ascertain its long-term outcomes. Conclusion Current evidence suggests that robotic and minimal invasive mitral valve surgeries are increasing in practice with satisfactory perioperative and mortality rates. However, long-term data is yet to be published to support current practice.
Collapse
Affiliation(s)
- Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest, Liverpool, UK
| | | | - Ka Siu Fan
- St. George's, University of London, London, UK
| |
Collapse
|
24
|
Jiang H, Liu Y, Yang Z, Ge Y, Li L, Wang H. Total Arch Replacement via Single Upper-Hemisternotomy Approach in Patients With Type A Dissection. Ann Thorac Surg 2020; 109:1394-1399. [DOI: 10.1016/j.athoracsur.2019.08.095] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 08/05/2019] [Accepted: 08/26/2019] [Indexed: 11/30/2022]
|
25
|
Mohammed H, Yousuf Salmasi M, Caputo M, Angelini GD, Vohra HA. Comparison of outcomes between minimally invasive and median sternotomy for double and triple valve surgery: A meta-analysis. J Card Surg 2020; 35:1209-1219. [PMID: 32306504 DOI: 10.1111/jocs.14558] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 03/31/2020] [Accepted: 04/06/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Limited data exists demonstrating the efficacy of minimally invasive surgery (MIS) compared to median sternotomy (MS) for multiple valvular disease (MVD). This systematic review and meta-analysis aims to compare operative and peri-operative outcomes of MIS vs MS in MVD. METHODS PubMed, Ovid, and Embase were searched from inception until August 2019 for randomized and observational studies comparing MIS and MS in patients with MVD. Clinical outcomes of intra- and postoperative times, reoperation for bleeding and surgical site infection were evaluated. RESULTS Five observational studies comparing 340 MIS vs 414 MS patients were eligible for qualitative and quantitative review. The quality of evidence assessed using the Newcastle-Ottawa scale was good for all included studies. Meta-analysis demonstrated increased cardiopulmonary bypass time for MIS patients (weighted mean difference [WMD], 0.487; 95% confidence interval [CI], 0.365-0.608; P < .0001). Similarly, aortic cross-clamp time was longer in patients undergoing MIS (WMD, 0.632; 95% CI, 0.509-0.755; P < .0001). No differences were found in operative mortality, reoperation for bleeding, surgical site infection, or hospital stay. CONCLUSIONS MIS for MVD have similar short-term outcomes compared to MS. This adds value to the use of minimally invasive methods for multivalvular surgery, despite conferring longer operative times. However, the paucity in literature and learning curve associated with MIS warrants further evidence, ideally randomized control trials, to support these findings.
Collapse
Affiliation(s)
- Haya Mohammed
- Faculty of Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Massimo Caputo
- Department of Cardiovascular Sciences, Bristol Heart Institute, University Hospitals Bristol, Bristol, UK
| | - Gianni D Angelini
- Department of Cardiovascular Sciences, Bristol Heart Institute, University Hospitals Bristol, Bristol, UK
| | - Hunaid A Vohra
- Department of Cardiovascular Sciences, Bristol Heart Institute, University Hospitals Bristol, Bristol, UK
| |
Collapse
|
26
|
Gumus F, Hasde AI, Bermede O, Kilickap M, Durdu MS. Multiple Valve Implantation Through a Minimally Invasive Approach: Comparison of Standard Median Sternotomy and Right Anterior Thoracotomy. Heart Lung Circ 2020; 29:1418-1423. [PMID: 32249168 DOI: 10.1016/j.hlc.2020.01.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 12/09/2019] [Accepted: 01/16/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Following developments in the area of minimally invasive surgery and good, recently published surgical results, the areas in which minimally invasive surgery can be used are beginning to expand. This study aimed to describe experience and show the feasibility and safety of minimally invasive multiple valve implantation with right anterior minithoracotomy (RAT) and compare the outcomes with cases that underwent multiple valve surgery via a standard median sternotomy. METHODS The study cohort comprised 52 patients with combined valvular disease who underwent aortic valve replacement and mitral valve replacement or repair, and/or tricuspid valve ring annuloplasty through median sternotomy (control group n=32) or minimally invasive surgery through a RAT (study group n=20) between January 2012 and December 2018 at the current centre. Preoperative evaluation included coronary catheterisation and multisliced computerised tomography in all patients. Postoperative clinical outcomes and haemodynamic performance of heart valves were reviewed. RESULTS The mean age of patients was 72.6±7.1 years, and 50% were male. Seventeen (17) patients (32.6%) were in New York Heart Association functional class III or IV. Three (3) patients (7.6%) had third-degree atrioventricular block requiring permanent pacemaker implantation. Mean follow-up was 21±3.9 months (maximum 26 months). No major paravalvular leakage occurred, and there was no postoperative valve migration in either group. Non-valve-related deaths occurred in five patients during follow-up. CONCLUSION This study showed that minimally invasive multiple valve implantation is a technically feasible and safe procedure with acceptable surgical outcomes and similar postoperative quality when compared with median sternotomy.
Collapse
Affiliation(s)
- Fatih Gumus
- Department of Cardiovascular Surgery, Heart Center, Cebeci Hospitals, Ankara University School of Medicine, Ankara, Turkey
| | - Ali Ihsan Hasde
- Department of Cardiovascular Surgery, Heart Center, Cebeci Hospitals, Ankara University School of Medicine, Ankara, Turkey
| | - Onat Bermede
- Department of Anesthesiology and Reanimation, Heart Center, Cebeci Hospitals, Ankara University School of Medicine, Ankara, Turkey
| | - Mustafa Kilickap
- Department of Cardiology, Heart Center, Cebeci Hospitals, Ankara University School of Medicine, Ankara, Turkey
| | - Mustafa Serkan Durdu
- Department of Cardiovascular Surgery, Heart Center, Cebeci Hospitals, Ankara University School of Medicine, Ankara, Turkey.
| |
Collapse
|
27
|
El Gamel A. Minimal Access Aortic Root Surgery: An "Elite Sport" or Is it for Everyone? Heart Lung Circ 2019; 28:1767-1769. [PMID: 31813479 DOI: 10.1016/j.hlc.2019.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Adam El Gamel
- Waikato Cardiothoracic Unit, Waikato Hospital, Hamilton, New Zealand; Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand; University of Waikato Medical Research Centre, The University of Waikato, New Zealand.
| |
Collapse
|
28
|
El Midany AAH, Doghish AA. Ministernotomy approach for modified Blalock-Taussig shunts in neonates: a feasibility study. THE CARDIOTHORACIC SURGEON 2019. [DOI: 10.1186/s43057-019-0004-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
29
|
Kastengren M, Svenarud P, Ahlsson A, Dalén M. Minimally invasive mitral valve surgery is associated with a low rate of complications. J Intern Med 2019; 286:614-626. [PMID: 31502720 DOI: 10.1111/joim.12974] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Minimally invasive mitral valve surgery is generally performed through a right minithoracotomy, in contrast to the traditional full median sternotomy approach. Minimally invasive mitral valve surgery is performed with increasing frequency, and by reducing surgical trauma, several observational studies suggest potential benefits with decreased bleeding and postoperative pain, reduced incidence of sternal wound infections, reduced length of hospital stay and shortened recovery period after surgery. In this review, we present an overview of mitral valve surgery, summarize the available evidence regarding the minimally invasive approach and report our experiences from introducing a minimally invasive mitral valve surgery programme at the Karolinska University Hospital in Stockholm, Sweden.
Collapse
Affiliation(s)
- M Kastengren
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - P Svenarud
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Cardiac Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - A Ahlsson
- Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - M Dalén
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Cardiac Surgery, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
30
|
Salmasi MY, Chien L, Hartley P, Al-Balah A, Lall K, Oo A, Casula R, Athanasiou T. What is the safety and efficacy of the use of automated fastener in heart valve surgery? J Card Surg 2019; 34:1598-1607. [PMID: 31725943 DOI: 10.1111/jocs.14265] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Cor-Knot automated fastener has been used as an adjunct in heart valve surgery to eliminate the need for manual tying during valve implantation. Although reduced operative time and facilitation for minimally invasive surgery are clear benefits, whether their use translates to improved patient outcome remains debatable. This study aims to review the safety and efficacy of automated fasteners in heart valve surgeries. METHOD Specific searches were conducted via online medical databases (Pubmed, Embase, Ovid) between 1950 and June 2019. Longitudinal studies were included that provided operative parameters. RESULTS The initial literature search identified 3773 articles, but only eight met the inclusion criteria and were used for analysis: four studies related to aortic valve replacement (AVR), four related to mitral valve (MV) intervention (total n = 810). The meta-analysis revealed the significantly shorter aortic cross-clamp time in the Cor-knot group compared to manual tying, both in AVR and MV surgeries (P < .05). Cardiopulmonary bypass time was significantly shorter in the Cor-knot group when analyzing studies in MV surgery (weighted mean difference [WMD]: 110.0; 95% confidence interval: 12.3-207.7; P = .027) The use of Cor-Knot did not increase the risk of permanent pacemaker implantation, paravalvular leak, and 30-day mortality. The majority of studies reported no change in the length of intensive unit care and total hospital stay. CONCLUSION We confirmed that the majority of existing literatures indicated the safety and intraoperative efficacy with automated fastener application. Nevertheless, there is currently no evidence to support automated fastened sutures can translate its intraoperative advantages to improved patient outcome.
Collapse
Affiliation(s)
- M Yousuf Salmasi
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Lueh Chien
- Department of Medical Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - Philip Hartley
- Department of Medical Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - Amer Al-Balah
- Department of Medical Sciences, Faculty of Medicine, Imperial College London, London, UK
| | | | - Aung Oo
- Barts Health Centre, Barts Health Trust, London, UK
| | - Roberto Casula
- Department of Cardiac Surgery, Hammersmith Hospital, London, UK
| | - Thanos Athanasiou
- Department of Surgery and Cancer, Imperial College London, London, UK
| |
Collapse
|
31
|
Hargrove WC, Goldstone AB. Commentary: Caveat Emptor. Semin Thorac Cardiovasc Surg 2019; 32:45-46. [PMID: 31634540 DOI: 10.1053/j.semtcvs.2019.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 10/10/2019] [Indexed: 11/11/2022]
Affiliation(s)
- W Clark Hargrove
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| | - Andrew B Goldstone
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
32
|
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.
Collapse
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
| |
Collapse
|
33
|
Khan H, Hadjittofi C, Uzzaman M, Salhiyyah K, Garg S, Butt S, Aya H, Chaubey S. External aortic clamping versus endoaortic balloon occlusion in minimally invasive cardiac surgery: a systematic review and meta-analysis. Interact Cardiovasc Thorac Surg 2019; 27:208-214. [PMID: 29506260 DOI: 10.1093/icvts/ivy016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 12/21/2017] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Minimally invasive cardiac valve surgery is safe, effective and increasingly popular. It is performed worldwide with the use of either external aortic clamping or endoaortic balloon occlusion. METHODS We conducted a literature search using MEDLINE, EMBASE, Scopus and Web of Science. Primary outcomes included aortic dissection, conversion to sternotomy, mortality, stroke and cross-clamp time. Secondary outcomes included atrial fibrillation, acute kidney injury, reoperation for bleeding, cardiopulmonary bypass times, myocardial infarction, use of intra-aortic balloon pump and length of hospital stay. The random effects model was used to calculate the outcomes of both binary and continuous data. RESULTS Thirty retrospective studies were included in the meta-analysis. The incidence of aortic dissection (pooled odds ratio = 3.88, 95% confidence interval = 1.06-14.18; P =0.04) and conversion to sternotomy (pooled odds ratio = 3.07, 95% confidence interval = 1.33-7.10; P = 0.009) was higher in the endoaortic balloon occlusion group than in the external aortic clamping group, in whom a direct comparison was possible. The remaining observational studies did not show any significant differences in either group. There was no significant difference in 30-day mortality (P = 0.37), stroke (P = 0.26), cross-clamp time (P = 0.20), atrial fibrillation (P = 0.18), acute kidney injury (P = 0.49), reoperation for bleeding (P = 0.24), cardiopulmonary bypass time (P = 0.06), myocardial infarction (P = 0.74), use of intra-aortic balloon pump (P = 0.11) or length of hospital stay (P = 0.47). CONCLUSIONS External aortic clamping may be safer than endoaortic balloon occlusion with respect to aortic dissection and conversion to sternotomy. However, mortality, length of stay, stroke, cross-clamp time and other cardiovascular complication rates were similar between the 2 techniques.
Collapse
Affiliation(s)
- Habib Khan
- Department of Cardiothoracic Surgery, Harefield Hospital, London, UK
| | | | - Mohsin Uzzaman
- Department of Cardiothoracic Surgery, University Hospital Coventry, Coventry, UK
| | - Kareem Salhiyyah
- Department of Cardiothoracic Surgery, Southampton University Hospital, Southampton, UK
| | - Sheena Garg
- Department of Cardiothoracic Surgery, Harefield Hospital, London, UK
| | - Salman Butt
- Department of Cardiothoracic, Kings College Hospital, London, UK
| | - Haleema Aya
- Department of Cardiothoracic, Kings College Hospital, London, UK
| | - Sanjay Chaubey
- Department of Cardiothoracic Surgery, Hammersmith Hospital, London, UK
| |
Collapse
|
34
|
Olds A, Saadat S, Azzolini A, Dombrovskiy V, Odroniec K, Lemaire A, Ghaly A, Lee LY. Improved operative and recovery times with mini-thoracotomy aortic valve replacement. J Cardiothorac Surg 2019; 14:91. [PMID: 31072356 PMCID: PMC6509756 DOI: 10.1186/s13019-019-0912-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 04/23/2019] [Indexed: 11/25/2022] Open
Abstract
Background The small incisions of minimally invasive surgery have the proposed benefit of less surgical trauma, less pain, and faster recovery. This study was done to compare minimally invasive techniques for aortic valve replacement, including right anterior mini-thoracotomy and mini-sternotomy, to conventional sternotomy. Methods We retrospectively reviewed 503 patients who underwent isolated aortic valve replacement at our institution from 2012 to 2015 using one of three techniques: 1) Mini-thoracotomy, 2) Mini-sternotomy, 3) Conventional sternotomy. Demographics, operative morbidity, mortality, and postoperative complications were compared. Results Of the 503 cases, 267 (53.1%) were mini-thoracotomy, 120 (23.8%) were mini-sternotomy, and 116 (23.1%) were conventional sternotomy. Mini-thoracotomy patients, compared to mini-sternotomy and conventional sternotomy, had significantly shorter bypass times [82 (IQ 67–113) minutes; vs. 117 (93.5–139.5); vs. 102.5 (85.5–132.5), respectively (p < 0.0001)], a lower incidence of prolonged ventilator support [3.75% vs. 9.17 and 12.9%, respectively (p = 0.0034)], and required significantly shorter ICU and postoperative stays, resulting in an overall shorter hospitalization [6 (IQ 5–9) days; vs. 7 (5–14.5); vs 9 (6–15.5), respectively (p < 0.05)]. Incidence of other postoperative complications were lower in the mini-thoracotomy group compared to mini-sternotomy and conventional sternotomy, without significance. Minimally invasive techniques trended towards better survival [mini-thoracotomy 1.5%, mini-sternotomy 1.67%, and conventional sternotomy 5.17% (p = 0.13)]. Conclusions Minimally invasive aortic valve replacement approaches are safe, effective alternatives to conventional sternotomy. The mini-thoracotomy approach showed decreased operative times, decreased lengths of stay, decreased incidence of prolonged ventilator time, and a trend towards lower mortality when compared to mini-sternotomy and conventional sternotomy.
Collapse
Affiliation(s)
- Anna Olds
- Division of Cardiothoracic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Siavash Saadat
- Division of Cardiothoracic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA. .,, Boston, USA.
| | - Anthony Azzolini
- Division of Cardiothoracic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Viktor Dombrovskiy
- Division of Cardiothoracic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Karen Odroniec
- Division of Cardiothoracic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Anthony Lemaire
- Division of Cardiothoracic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Aziz Ghaly
- Division of Cardiothoracic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Leonard Y Lee
- Division of Cardiothoracic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| |
Collapse
|
35
|
The first 5 years: Building a minimally invasive valve program. J Thorac Cardiovasc Surg 2019; 157:1958-1965. [DOI: 10.1016/j.jtcvs.2018.10.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 09/24/2018] [Accepted: 10/03/2018] [Indexed: 12/20/2022]
|
36
|
Vukovic PM, Milojevic P, Stojanovic I, Micovic S, Zivkovic I, Peric M, Milicic M, Milacic P, Milojevic M, Bojic M. The role of ministernotomy in aortic valve surgery—A prospective randomized study. J Card Surg 2019; 34:435-439. [DOI: 10.1111/jocs.14053] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/31/2019] [Accepted: 04/02/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Petar M. Vukovic
- Department of Cardiac SurgeryDedinje Cardiovascular InstituteBelgrade Serbia
| | - Predrag Milojevic
- Department of Cardiac SurgeryDedinje Cardiovascular InstituteBelgrade Serbia
| | - Ivan Stojanovic
- Department of Cardiac SurgeryDedinje Cardiovascular InstituteBelgrade Serbia
| | - Slobodan Micovic
- Department of Cardiac SurgeryDedinje Cardiovascular InstituteBelgrade Serbia
| | - Igor Zivkovic
- Department of Cardiac SurgeryDedinje Cardiovascular InstituteBelgrade Serbia
| | - Miodrag Peric
- Department of Cardiac SurgeryDedinje Cardiovascular InstituteBelgrade Serbia
| | - Miroslav Milicic
- Department of Cardiac SurgeryDedinje Cardiovascular InstituteBelgrade Serbia
| | - Petar Milacic
- Department of Cardiac SurgeryDedinje Cardiovascular InstituteBelgrade Serbia
| | - Milan Milojevic
- Department of Cardiac SurgeryDedinje Cardiovascular InstituteBelgrade Serbia
| | - Milovan Bojic
- Department of Cardiac SurgeryDedinje Cardiovascular InstituteBelgrade Serbia
| |
Collapse
|
37
|
Wood KL, Ayers BC, Sagebin F, Vidula H, Thomas S, Alexis JD, Barrus B, Knight P, Prasad S, Gosev I. Complete Sternal-Sparing HeartMate 3 Implantation: A Case Series of 10 Consecutive Patients. Ann Thorac Surg 2019; 107:1160-1165. [DOI: 10.1016/j.athoracsur.2018.10.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 09/14/2018] [Accepted: 10/10/2018] [Indexed: 11/25/2022]
|
38
|
Jahangiri M, Hussain A, Akowuah E. Minimally invasive surgical aortic valve replacement. Heart 2019; 105:s10-s15. [DOI: 10.1136/heartjnl-2018-313512] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 10/12/2018] [Accepted: 10/16/2018] [Indexed: 11/03/2022] Open
Abstract
Minimally invasive aortic valve replacement (MIAVR) is defined as a surgical aortic valve replacement which involves smaller chest incisions as opposed to full sternotomy. It is performed using cardiopulmonary bypass with cardiac arrest. It benefits from potential advantages of a less invasive procedure. To date, over 14 000 MIAVR have been reported in the literature. Due to heterogeneity of the studies, different surgical techniques and mainly the non-randomised nature of these studies comparing MIAVR with conventional aortic valve replacement, it is difficult to draw definitive conclusions. The two main techniques of MIAVR are mini-sternotomy and right anterior mini-thoracotomy. Both techniques with other less common forms of MIAVR will be discussed in this review. The advantages, disadvantages and surgical pitfalls will be discussed. Some of the advantages include shorter intensive care and hospital stay, reduced perioperative blood loss, less pain, improved respiratory function and cosmesis. The possible disadvantage of longer bypass and cross-clamp times may be counter balanced by the recent sutureless and rapid deployment valves. Despite some of the benefits, MIAVR has not been adopted by a significant proportion of the surgeons possibly related to the learning curve and requirements for re-training. As MIAVR becomes more common, randomised trials comparing this technique with transcatheter aortic valve implantation is warranted. In addition, assessing quality of life including return to work and functional capacity is needed.
Collapse
|
39
|
Huang M, Piao H, Li B, Wang Y, Wang T, Zhu Z, Li D, Liu K. A new inclusion technique through an upper partial sternotomy for complicated Stanford B-type aortic dissection with an aberrant right subclavian artery: A case report. Medicine (Baltimore) 2019; 98:e14727. [PMID: 30882638 PMCID: PMC6426566 DOI: 10.1097/md.0000000000014727] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
RATIONALE An aberrant right subclavian artery (ARSA), arising from the proximal descending aorta, is a common aortic arch anomaly, with an incidence of 0.5% to 2%. However, coexistence of dissection and an ARSA is extremely rare. We presented the first case of successful management of complicated Stanford B-type aortic dissection combined with an ARSA with a new inclusion technique and stent graft (SG) implantation through an upper partial sternotomy. PATIENT CONCERNS A 39-year-old woman with a history of severe hypertension was admitted to our hospital because of sudden-onset chest and upper back pain. DIAGNOSES Aortic computed tomography angiography (CTA) demonstrated complicated Stanford B-type dissection with ARSA. INTERVENTIONS A new inclusion technique and SG implantation through an upper partial sternotomy were performed for the patient, whose aortic arch branch vessels, including ARSA, were fully preserved. OUTCOMES The patient had an uneventful postoperative course without neurologic deficits, and no blood transfusion was required during the hospitalization. The false lumen completely disappeared on postoperative CTA. LESSONS This new inclusion technique through an upper partial sternotomy is a safe and feasible treatment for complicated Stanford B-type aortic dissection with an ARSA with the primary tear located in the aortic arch.
Collapse
|
40
|
Kocabeyoglu SS, Kervan U, Sert DE, Unal EU, Demirkan B, Guray Y, Aygun E, Beyazal OF, Karahan M, Pac M. Is it Possible to Implant HeartMate 3 Less Invasively? New Pump, New Approach. Artif Organs 2018; 42:1132-1138. [DOI: 10.1111/aor.13289] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 05/08/2018] [Accepted: 05/10/2018] [Indexed: 11/28/2022]
Affiliation(s)
| | - Umit Kervan
- Department of Cardiovascular Surgery; Turkiye Yuksek Ihtisas Hospital; Ankara Turkey
| | - Dogan Emre Sert
- Department of Cardiovascular Surgery; Turkiye Yuksek Ihtisas Hospital; Ankara Turkey
| | - Ertekin Utku Unal
- Department of Cardiovascular Surgery; Turkiye Yuksek Ihtisas Hospital; Ankara Turkey
| | - Burcu Demirkan
- Department of Cardiology; Turkiye Yuksek Ihtisas Hospital; Ankara Turkey
| | - Yesim Guray
- Department of Cardiology; Turkiye Yuksek Ihtisas Hospital; Ankara Turkey
| | - Emre Aygun
- Department of Cardiovascular Surgery; Turkiye Yuksek Ihtisas Hospital; Ankara Turkey
| | - Osman Fehmi Beyazal
- Department of Cardiovascular Surgery; Turkiye Yuksek Ihtisas Hospital; Ankara Turkey
| | - Mehmet Karahan
- Department of Cardiovascular Surgery; Turkiye Yuksek Ihtisas Hospital; Ankara Turkey
| | - Mustafa Pac
- Department of Cardiovascular Surgery; Turkiye Yuksek Ihtisas Hospital; Ankara Turkey
| |
Collapse
|
41
|
Left Lateral Thoracotomy for Centrifugal Continuous-Flow Left Ventricular Assist Device Placement: An Analysis from the Mechanical Circulatory Support Research Network. ASAIO J 2018; 64:715-720. [DOI: 10.1097/mat.0000000000000714] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
42
|
Riebandt J, Wiedemann D, Simon P, Dimitrov K, Laufer G, Zimpfer D. Use of the Novel Surgical Enhancement Tools for Less Invasive Abbott HeartMate 3 Implantation. Ann Thorac Surg 2018; 106:e209-e210. [DOI: 10.1016/j.athoracsur.2018.04.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 04/04/2018] [Accepted: 04/09/2018] [Indexed: 11/24/2022]
|
43
|
Monsefi N, Risteski P, Miskovic A, Zierer A, Moritz A. Propensity-matched comparison between minimally invasive and conventional sternotomy in aortic valve resuspension. Eur J Cardiothorac Surg 2018; 53:1258-1263. [PMID: 29351595 DOI: 10.1093/ejcts/ezx489] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 12/02/2017] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The aim of the study was to compare the results of David procedure through conventional or minimally invasive approach. METHODS A propensity-matched comparison in patients undergoing a minimally invasive (partial upper sternotomy, n = 103) or complete sternotomy (n = 103) David procedure from 1991 to 2016 was performed. Patients were 57 ± 14 years old on average in both groups. The David technique was modified by generating a neosinus (P < 0.01) in 99 (96%) patients (minimally invasive group) and in 42 (41%) patients (complete sternotomy group), respectively. The average follow-up time was 3 ± 2 years (minimally invasive group) and 8 ± 4 years (complete sternotomy group). RESULTS There was only 1 in-hospital death (in the full sternotomy group, P = 0.5). The applied quantity of packed red blood cells (pRBC) was significantly higher in the complete sternotomy group (3.4 ± 4 vs 1 ± 0.5, P < 0.01). There were no late deaths in the minimally invasive group but 14 died during a longer follow-up period in the full sternotomy group (P < 0.01). Freedom from reoperation or aortic valve insufficiency ≥2° was 95% vs 93% (minimally invasive versus complete sternotomy group) at 5 years and 95% vs 79% at 10 years (P < 0.01). CONCLUSIONS The minimally invasive aortic valve reimplantation procedure for selected patients with aortic root aneurysm and aortic valve incompetence is a durable procedure with minor valve-related morbidity and mortality at the mid-term follow-up. The intra- and perioperative application of pRBC was significantly lower in the minimally invasive group. However, comparison of long-term follow-up data in both groups is necessary to evaluate valve function.
Collapse
Affiliation(s)
- Nadejda Monsefi
- Department of Thoracic and Cardiovascular Surgery, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
| | - Petar Risteski
- Department of Thoracic and Cardiovascular Surgery, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
| | - Aleksandra Miskovic
- Department of Thoracic and Cardiovascular Surgery, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
| | - Andreas Zierer
- Department of Thoracic and Cardiovascular Surgery, Kepler University Hospital, Linz, Austria
| | - Anton Moritz
- Department of Thoracic and Cardiovascular Surgery, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
| |
Collapse
|
44
|
Wilbring M, Charitos E, Silaschi M, Treede H. Minimally invasive mitral valve surgery. Indian J Thorac Cardiovasc Surg 2018. [DOI: 10.1007/s12055-018-0672-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
45
|
Minimally invasive aortic valve replacement: is the effort justified? Indian J Thorac Cardiovasc Surg 2018. [DOI: 10.1007/s12055-017-0640-9] [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] Open
|
46
|
Sternotomy Sparing Thoratec Heartmate 3 Implantation via Bilateral Minithoracotomy. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2018; 13:74-76. [DOI: 10.1097/imi.0000000000000460] [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
A novel sternotomy sparing implantation technique for the Thoratec HeartMate 3 is described. Cannulation of the left ventricular apex is performed via a minithoracotomy in the left fourth or fifth intercostal space. The outflow graft is advanced through the pericardium to a second minithoracotomy in the right second intercostal space and then anastomosed to the ascending aorta. This approach was performed in three patients so far with no need for conversion. We did not observe any perioperative adverse events, such as bleeding or thromboembolic complications, as well as no short-term mortality. This technique is especially appealing in multimorbid and frail patients, future transplant candidates, and patients with impaired right ventricular function.
Collapse
|
47
|
Riebandt J, Wiedemann D, Laufer G, Zimpfer D. Sternotomy Sparing Thoratec Heartmate 3 Implantation via Bilateral Minithoracotomy. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2018. [DOI: 10.1177/155698451801300116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Julia Riebandt
- Department of Cardiac Surgery, Medical University Vienna, Vienna, Austria
| | - Dominik Wiedemann
- Department of Cardiac Surgery, Medical University Vienna, Vienna, Austria
| | - Guenther Laufer
- Department of Cardiac Surgery, Medical University Vienna, Vienna, Austria
| | - Daniel Zimpfer
- Department of Cardiac Surgery, Medical University Vienna, Vienna, Austria
| |
Collapse
|
48
|
Fudulu D, Lewis H, Benedetto U, Caputo M, Angelini G, Vohra HA. Minimally invasive aortic valve replacement in high risk patient groups. J Thorac Dis 2017; 9:1672-1696. [PMID: 28740685 DOI: 10.21037/jtd.2017.05.21] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Minimally invasive aortic valve replacement (AVR) aims to preserve the sternal integrity and improve postoperative outcomes. In low risk patients, this technique can be achieved with comparable mortality to the conventional approach and there is evidence of possible reduction in intensive care and hospital length of stay, transfusion requirement, renal dysfunction, improved respiratory function and increased patient satisfaction. In this review, we aim to asses if these benefits can be transferred to the high risk patient groups. We therefore, discuss the available evidence for the following high risk groups: elderly patients, re-operative surgery, poor lung function, pulmonary hypertension, obesity, concomitant procedures and high risk score cohorts.
Collapse
Affiliation(s)
- Daniel Fudulu
- Department of Cardiac Surgery, University Bristol Hospitals NHS Foundation Trust, Bristol, UK
| | - Harriet Lewis
- Department of Cardiac Surgery, University Bristol Hospitals NHS Foundation Trust, Bristol, UK
| | - Umberto Benedetto
- Department of Cardiac Surgery, University Bristol Hospitals NHS Foundation Trust, Bristol, UK
| | - Massimo Caputo
- Department of Cardiac Surgery, University Bristol Hospitals NHS Foundation Trust, Bristol, UK
| | - Gianni Angelini
- Department of Cardiac Surgery, University Bristol Hospitals NHS Foundation Trust, Bristol, UK
| | - Hunaid A Vohra
- Department of Cardiac Surgery, University Bristol Hospitals NHS Foundation Trust, Bristol, UK
| |
Collapse
|
49
|
Ramlawi B, Bedeir K, Lamelas J. Aortic Valve Surgery: Minimally Invasive Options. Methodist Debakey Cardiovasc J 2017; 12:27-32. [PMID: 27127559 DOI: 10.14797/mdcj-12-1-27] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Minimally invasive aortic valve surgery has not been adopted by a significant proportion of cardiac surgeons despite proven benefits. This may be related to a high learning curve and technical issues requiring retraining. In this review, we discuss the data for minimally invasive aortic valve surgery and describe our operative technique for both ministernotomy and anterior thoracotomy approaches. We also discuss the advent of novel sutureless valves and how these techniques compare to available transcatheter aortic valve procedures.
Collapse
|
50
|
Risteski P, Monsefi N, Miskovic A, Josic T, Bala S, Salem R, Zierer A, Moritz A. Triple valve surgery through a less invasive approach: early and mid-term results. Interact Cardiovasc Thorac Surg 2017; 24:677-682. [PMID: 28453792 DOI: 10.1093/icvts/ivw430] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 10/19/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES A partial upper sternotomy has become established as a less invasive approach mainly for single and double valve surgery. This report evaluates the clinical outcomes of triple valve surgery performed through a partial upper sternotomy. METHODS We reviewed the medical records of 37 consecutive patients (28 men, 76%) who underwent triple valve surgery through a partial upper sternotomy between 2005 and 2015. The patients' mean age was 67 ± 17 years; 27 (73%) were in New York Heart Association Class III or IV. Aortic and mitral valve insufficiency was more common than stenosis. Ninety-three percent of surviving patients were followed for a mean period of 58 ± 24 months. RESULTS Aortic valve procedures consisted of 24 (65%) replacements and 13 (35%) repairs. The mitral valve was repaired in 28 (76%) patients, whereas tricuspid valve repair was feasible in all patients. No conversion to full sternotomy was necessary. Myocardial infarction was not observed. Chest tube drainage was 330 ± 190 ml, and 4 patients required reopening for bleeding (1, 3%) or tamponade (3, 8%). One stroke was observed due to heparin-induced thrombocytopaenia after initial unremarkable neurological recovery. Early mortality included 5 (13.5%) patients. Actuarial survival at 5 years was 52 ± 10%. CONCLUSIONS A partial upper sternotomy provides adequate exposure to all heart valves. We did not experience technical limitations with this approach. Wound dehiscence, postoperative bleeding, intensive care unit and hospital stay and early deaths were low compared to data from other published series of triple valve surgery through a full median sternotomy. Early and mid-term outcomes were not adversely affected by this less invasive approach.
Collapse
Affiliation(s)
- Petar Risteski
- Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University Hospital, Frankfurt am Main, Germany
| | - Nadejda Monsefi
- Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University Hospital, Frankfurt am Main, Germany
| | - Aleksandra Miskovic
- Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University Hospital, Frankfurt am Main, Germany
| | - Tanja Josic
- Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University Hospital, Frankfurt am Main, Germany
| | - Sherife Bala
- Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University Hospital, Frankfurt am Main, Germany
| | - Razan Salem
- Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University Hospital, Frankfurt am Main, Germany
| | - Andreas Zierer
- Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University Hospital, Frankfurt am Main, Germany
| | - Anton Moritz
- Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University Hospital, Frankfurt am Main, Germany
| |
Collapse
|