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Hamiko M, Salamate S, Nassari MA, Spaeth A, Sirat S, Doss M, Amer M, Silaschi M, Ahmad AES, Bakhtiary F. Totally Endoscopic Replacement of the Ascending Aorta and the Aortic Root including the Aortic Valve via Right Mini-Thoracotomy: A Multicenter Study. J Clin Med 2024; 13:2648. [PMID: 38731177 PMCID: PMC11084888 DOI: 10.3390/jcm13092648] [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: 04/11/2024] [Revised: 04/22/2024] [Accepted: 04/29/2024] [Indexed: 05/13/2024] Open
Abstract
Background: Recently, minimally invasive access via right anterolateral mini-thoracotomy (RAMT) has been gaining popularity in cardiac surgery. This approach is also an option for surgeons performing aortic surgery. The aim of this study is to present our surgical method, highlighting the total endoscopic minimally invasive approach via RAMT for replacement of the ascending aorta (AAR) with or without involvement of the aortic root and the aortic valve. Methods: Clinical data of 44 patients from three participating institutions with AAR with or without involvement of the aortic valve or aortic root via RAMT between April 2017 and February 2024 were retrospectively analyzed. According to surgical procedure, patients were divided into two groups, in the AAR and in the Wheat/Bentall group with concomitant valve or root replacement. Operative time, length of ventilation, perioperative outcome, length of intensive care unit (ICU) as well as postoperative hospital stay, and mid- and long-term results were retrospectively analyzed. Results: Mean age was 61.4 ± 10.7 years old with a frequency of male gender of 63.6%. Mean cardiopulmonary bypass (CBP) time and aortic cross-clamping time was 94.9 ± 32.5 min and 63.8 ± 25.9 min, respectively. CPB and aortic clamp time were significantly lower in AAR group. In the first 24 h, the mean drainage volume was 790.3 ± 423.6 mL. Re-thoracotomy due to bleeding was zero. Sternotomy was able to be avoided in all patients. Patients stayed 35.9 ± 23.5 h at ICU and were discharged 7.8 ± 3.0 days following surgery from hospital. Mean ventilation time was 5.8 ± 7.6 h. All patients survived and 30-day mortality was 0.0%. At a median follow-up time of 18.2 months, all patients were alive. The results were similar in both groups. Conclusions: The full endoscopic RAMT approach with 3D visualization is a safe, feasible and promising technique that can be transferred in the field of aortic surgery without compromising surgical quality, postoperative outcomes, or patient safety when performed by an experienced team in a high-volume center.
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Affiliation(s)
- Marwan Hamiko
- Department of Cardiac Surgery, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany; (S.S.); (M.A.N.); (A.S.); (M.S.); (A.E.-S.A.); (F.B.)
| | - Saad Salamate
- Department of Cardiac Surgery, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany; (S.S.); (M.A.N.); (A.S.); (M.S.); (A.E.-S.A.); (F.B.)
| | - Maedeh Ayay Nassari
- Department of Cardiac Surgery, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany; (S.S.); (M.A.N.); (A.S.); (M.S.); (A.E.-S.A.); (F.B.)
| | - Andre Spaeth
- Department of Cardiac Surgery, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany; (S.S.); (M.A.N.); (A.S.); (M.S.); (A.E.-S.A.); (F.B.)
| | - Sami Sirat
- Department of Cardiac Surgery, Helios Hospital Siegburg, 53721 Siegburg, Germany; (S.S.); (M.D.)
| | - Mirko Doss
- Department of Cardiac Surgery, Helios Hospital Siegburg, 53721 Siegburg, Germany; (S.S.); (M.D.)
| | - Mohamed Amer
- Department of Cardiac Surgery, Helios Hospital Wuppertal, 42283 Wuppertal, Germany;
| | - Miriam Silaschi
- Department of Cardiac Surgery, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany; (S.S.); (M.A.N.); (A.S.); (M.S.); (A.E.-S.A.); (F.B.)
| | - Ali El-Sayed Ahmad
- Department of Cardiac Surgery, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany; (S.S.); (M.A.N.); (A.S.); (M.S.); (A.E.-S.A.); (F.B.)
| | - Farhad Bakhtiary
- Department of Cardiac Surgery, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany; (S.S.); (M.A.N.); (A.S.); (M.S.); (A.E.-S.A.); (F.B.)
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Elghannam M, Useini D, Moustafine V, Bechtel M, Naraghi H, Strauch JT, Haldenwang PL. Minimally Invasive versus Conventional Aortic Root Surgery: Results of an Intermediate-Volume Center. Thorac Cardiovasc Surg 2024; 72:118-125. [PMID: 37040869 DOI: 10.1055/a-2041-3695] [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: 02/25/2023]
Abstract
BACKGROUND We evaluate the outcome of aortic root surgery via an upper J: -shaped mini-sternotomy (MS) versus full sternotomy (FS) in an intermediate-volume center. METHODS Between November 2011 and February 2019, 94 consecutive patients underwent aortic root surgery: 62 (66%) patients were operated via a J: -shaped MS (group A) and 32 (34%) patients via FS (group B). The primary endpoints were mortality, major adverse cardiac and cerebral events (MACCE), and reoperation in a 2-year follow-up. The secondary endpoints were perioperative complications and patient's satisfaction with the procedural results. RESULTS Valve sparing root replacement (David procedure) was performed in 13 (21%) of the MS and 7 (22%) of the FS patients. The Bentall procedure in MS versus FS was 49 (79%) versus 25 (78%), respectively. Both groups presented similar mean operation, cardiopulmonary bypass, and cross-clamp times. Postoperative bleeding was 534 ± 300 and 755 ± 402 mL (p = 0.01) in MS and FS, respectively, erythrocyte concentrate substitution was 3 ± 3 and 5.3 ± 4.8 (p = 0.018) in MS and FS, respectively, and pneumonia rates were 0 and 9.4% (p = 0.03) in MS and FS, respectively. The 30-day mortality was 0% in both groups, whereas MACCE was 1.6 and 3% (p = 0.45) in MS and FS, respectively. After 2 years, the mortality and MACCE were 4.6 and 9.5% (p = 0.11) and 4.6 and 0% (p = 0.66) in MS and FS, respectively. The number of patients who were satisfied with the surgical cosmetic results in groups A and B was 53 (85.4%) and 26 (81%), respectively. CONCLUSION Aortic root surgery via MS is a safe alternative to FS even in an intermediate-volume center. It offers a shorter recovery time and similar midterm results.
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Affiliation(s)
- Mahmoud Elghannam
- Department of Cardiothoracic Surgery, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Nordrhein-Westfalen, Germany
| | - Dritan Useini
- Department of Cardiothoracic Surgery, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Nordrhein-Westfalen, Germany
| | - Vadim Moustafine
- Department of Cardiothoracic Surgery, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Nordrhein-Westfalen, Germany
| | - Matthias Bechtel
- Department of Cardiothoracic Surgery, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Nordrhein-Westfalen, Germany
| | - Hamid Naraghi
- Department of Cardiothoracic Surgery, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Nordrhein-Westfalen, Germany
| | - Justus T Strauch
- Department of Cardiothoracic Surgery, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Nordrhein-Westfalen, Germany
| | - Peter Lukas Haldenwang
- Department of Cardiothoracic Surgery, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Nordrhein-Westfalen, Germany
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Tchana-Sato V, Bruls S, Minga Lowampa E, Houben A, Desiron Q, Hans G, Lagny MG, Jaquet O, Defraigne JO, Lavigne JP. Surgery of the ascending aorta via a right anterior minithoracotomy: initial surgical experience of a single center. Acta Chir Belg 2024; 124:28-34. [PMID: 36424303 DOI: 10.1080/00015458.2022.2152240] [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: 07/07/2022] [Accepted: 11/22/2022] [Indexed: 12/05/2022]
Abstract
OBJECTIVES Full median sternotomy (FMS) is the common surgical access for patients undergoing replacement of the ascending aorta (AA) with or without aortic valve replacement (AVR). The right anterior mini-thoracotomy (RAMT) approach has been increasingly adopted for AVR. This approach has been shown to decrease blood loss and hospital length of stay (LOS) compared with FMS. The RAMT approach may also be beneficial in selected patients requiring AA procedures with or without AVR. We present our initial clinical experience of patients who have undergone a RAMT for supracommissural replacement of the tubular AA with or without AVR. METHODS This is a single-center retrospective review of 10 patients who underwent an elective RAMT for replacement of the tubular AA with or without AVR between November 2019 and January 2022. Clinical outcomes evaluated include 30-day mortality, intensive care and hospital LOS, time to extubation, operative times, as well as postoperative complications such as stroke and bleeding. RESULTS Median cross-clamp and cardiopulmonary bypass times were 109 and 148 min, respectively. Median time to extubation was 2.5 h and median intensive care unit and hospital stay were 2 and 10 days, respectively. There were two re-thoracotomies for postoperative bleeding and two cases of sub-xiphoidal pericardial drainage for pericardial effusion. There were no strokes and no in-hospital nor 30-day mortalities. CONCLUSIONS The replacement of the AA with or without concomitant AVR can be performed through a RAMT in carefully selected patients. However, the safety of this approach, as compared to full/partial median sternotomy, remains to be proven.
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Affiliation(s)
| | - Samuel Bruls
- Department of Cardiovascular Surgery, CHU Liege, Liege, Belgium
| | | | - Alan Houben
- Department of Anesthesiology, CHU Liege, Liege, Belgium
| | - Quentin Desiron
- Department of Cardiovascular Surgery, CHU Liege, Liege, Belgium
| | - Gregory Hans
- Department of Anesthesiology, CHU Liege, Liege, Belgium
| | | | - Oceane Jaquet
- Department of Anesthesiology, CHU Liege, Liege, Belgium
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Helms F, Schmack B, Weymann A, Hanke JS, Natanov R, Martens A, Ruhparwar A, Popov AF. Expanding the Minimally Invasive Approach towards the Ascending Aorta-A Practical Overview of the Currently Available Techniques. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1618. [PMID: 37763737 PMCID: PMC10534602 DOI: 10.3390/medicina59091618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/28/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023]
Abstract
Minimally invasive techniques have gained immense importance in cardiovascular surgery. While minimal access strategies for coronary and mitral valve surgery are already widely accepted and often used as standard approaches, the application of minimally invasive techniques is currently expanded towards more complex operations of the ascending aorta as well. In this new and developing field, various techniques have been established and reported ranging from upper hemisternotomy approaches, which allow even extensive operations of the ascending aorta to be performed through a minimally invasive access to sternal sparing thoracotomy strategies, which completely avoid sternal trauma during ascending aorta replacements. All of these techniques place high demands on patient selection, preoperative planning, and practical surgical implementation. Application of these strategies is currently limited to high-volume centers and highly experienced surgeons. This narrative review gives an overview of the currently available techniques with a special focus on the practical execution as well as the advantages and disadvantages of the currently available techniques. The first results demonstrate the practicability and safety of minimally invasive techniques for replacement of the ascending aorta in a well-selected patient population. With success and complication rates comparable to classic full sternotomy, the proof of concept for minimally invasive replacement of the ascending aorta is now achieved.
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Affiliation(s)
- Florian Helms
- Division for Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany
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Kirmani BH, Akowuah E. Minimal Access Aortic Valve Surgery. J Cardiovasc Dev Dis 2023; 10:281. [PMID: 37504537 PMCID: PMC10380690 DOI: 10.3390/jcdd10070281] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/24/2023] [Accepted: 06/26/2023] [Indexed: 07/29/2023] Open
Abstract
Minimally invasive approaches to the aortic valve have been described since 1993, with great hopes that they would become universal and facilitate day-case cardiac surgery. The literature has shown that these procedures can be undertaken with equivalent mortality rates, similar operative times, comparable costs, and some benefits regarding hospital length of stay. The competing efforts of transcatheter aortic valve implantation for these same outcomes have provided an excellent range of treatment options for patients from cardiology teams. We describe the current state of the art, including technical considerations, caveats, and complications of minimal access aortic surgery and predict future directions in this space.
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Affiliation(s)
- Bilal H Kirmani
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UK
| | - Enoch Akowuah
- Cardiac Surgery, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
- Academic Cardiovascular Unit, South Tees NHS Foundation Trust, Middlesbrough TS4 3BW, UK
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Luo ZR, Chen YX, Chen LW. Surgical outcomes associated with partial upper sternotomy in obese aortic disease patients. J Cardiothorac Surg 2022; 17:135. [PMID: 35641935 PMCID: PMC9158371 DOI: 10.1186/s13019-022-01890-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 05/19/2022] [Indexed: 11/23/2022] Open
Abstract
Background Excellent partial upper sternotomy outcomes have been reported for patients undergoing aortic surgery, but whether this approach is particularly beneficial to obese patients remains to be established. This study was developed to explore the outcomes of aortic surgical procedures conducted via a partial upper sternotomy or a full median sternotomy approach in obese patients. Methods We retrospectively examined consecutive acute type A aortic dissection patients who underwent aortic surgery in our hospital between January 2015 to January 2021. Patients were divided into two groups based on body mass index: ‘non-obese’ and ‘obese’. We then further stratified patients in the obese and non-obese groups into partial upper sternotomy and full median sternotomy groups, with outcomes between these two sternotomy groups then being compared within and between these two body mass index groups. Results In total, records for 493 patients that had undergone aortic surgery were retrospectively reviewed, leading to the identification of 158 consecutive obese patients and 335 non-obese patients. Overall, 88 and 70 obese patients underwent full median sternotomy and partial upper sternotomy, respectively, while 180 and 155 non-obese patients underwent these respective procedures. There were no differences between the full median sternotomy and partial upper sternotomy groups within either BMI cohort with respect to preoperative baseline indicators and postoperative complications. Among non-obese individuals, the partial upper sternotomy approach was associated with reduced ventilation time (P = 0.003), shorter intensive care unit stay (P = 0.017), shorter duration of hospitalization (P = 0.001), and decreased transfusion requirements (Packed red blood cells: P < 0.001; Fresh frozen plasma: P < 0.001). Comparable findings were also evident among obese patients. Conclusions Obese aortic disease patients exhibited beneficial outcomes similar to those achieved for non-obese patients via a partial upper sternotomy approach which was associated with significant reductions in the duration of intensive care unit residency, duration of hospitalization, ventilator use, and transfusion requirements. This surgical approach should thus be offered to aortic disease patients irrespective of their body mass index.
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Affiliation(s)
- Zeng-Rong Luo
- Department of Cardiovascular Surgery and Cardiac Disease Center, Union Hospital, Fujian Medical University, Fuzhou, 350001, People's Republic of China
| | - Yi-Xing Chen
- Department of Cardiology, Nan Ping First Hospital Affiliated to Fujian Medical University, Nanping, 353000, People's Republic of China
| | - Liang-Wan Chen
- Department of Cardiovascular Surgery and Cardiac Disease Center, Union Hospital, Fujian Medical University, Fuzhou, 350001, People's Republic of China.
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Boudart A, Yilmaz A, Kaya A. Minimal access compared to sternotomy for aortic root and arch surgery. Acta Chir Belg 2022; 122:144-149. [PMID: 35255771 DOI: 10.1080/00015458.2022.2050979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Partial upper sternotomy is an established technique for aortic valve surgery in numerous centers. Based on the favorable results, this access can be extended for more complex procedures. We assessed the outcomes of aortic root and arch surgery through partial versus full sternotomy. PATIENTS AND METHODS From January 2013 to December 2020, 100 patients underwent proximal aortic surgery. The minimal access approach was used in 73 patients. Operative variables and outcomes were retrospectively analyzed and compared between both groups. RESULTS There was no significant difference in cross-clamping and extracorporeal circulation times, as well as no difference in postoperative acute renal failure, stroke, myocardial infarction, and re-exploration for bleeding. However, there was a significant difference in favor of partial upper sternotomy in red blood cell transfusion (0 vs. 234 mL; p = 0.01), postoperative drainage volume (300 vs. 750 mL; p < 0.001), ventilation time (median 3 vs. 24 h; p < 0.001), sepsis (1 [1.4%] vs. 4 [14.8%]; p = 0.02), intensive care unit (median 2 vs. 4 days; p = 0.002) and hospital stay (median 7 vs. 10 days; p < 0.001). Only one patient required intraoperative conversion due to massive bleeding. There was no difference in 30-day mortality between both groups. CONCLUSION The partial upper sternotomy approach is safe and feasible for aortic root and arch surgery with morbidity and mortality rates similar to full sternotomy, with the advantages of less blood loss and transfusions need, faster extubation, and shorter length of hospital stay.
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Qiu Z, Xiao J, Wu Q, Chai T, Zhang L, Li Y, Chen L. Partial upper sternotomy for extensive arch repair in older acute type A aortic dissection patients. BMC Cardiovasc Disord 2022; 22:117. [PMID: 35313815 PMCID: PMC8939131 DOI: 10.1186/s12872-022-02511-1] [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: 09/06/2021] [Accepted: 02/14/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES The partial upper sternotomy (PUS) approach is acceptable for aortic valve replacement, and even aortic root operation. However, the efficiency of PUS for extensive arch repair of acute type A aortic dissection (AAAD) in older adult patients has not been well investigated. METHODS Between January 2014 and December 2019, 222 older adult patients (≥ 65 years) diagnosed with AAAD went through extensive arch repair, among which 127 received PUS, and 95 underwent full sternotomy (FS). Logistic regression analysis was used to identify risk factors for early death, and negative binomial regression analysis was applied to explore risk factors related to post-operative ventilator-supporting time and intensive care unit stay time. RESULTS Total early mortality was 8.1% (18/222 patients). The PUS group had shorter Cardiopulmonary bypass time (133.0 vs.155.0 min, P < 0.001), cross-clamp time (44.0 vs. 61.0 min, P < 0.001) and shorter selective cerebral perfusion time (11.0 vs. 21.0 min, P < 0.001) than the FS group. Left ventricle ejection fraction < 50% (odds ratio [OR] 17.05; 95% confidence interval [CI] 1.87-155.63; P = 0.012) and malperfusion syndromes (OR 65.83; 95% CI 11.53-375.86; P < 0.001) were related to early death. In the multivariate model, the PUS approach contributed to shorter ventilator-supporting time (incidence rate ratio [IRR] 0.76; 95% CI 0.64-0.91; P = 0.003), when compared with the FS group. CONCLUSIONS The early results of emergency extensive arch repair of AAAD via PUS in older adult patients were satisfactory. However, the long-term results remain to be investigated.
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Affiliation(s)
- Zhihuang Qiu
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001, Fujian, China.,Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fujian Province University, Fuzhou, 350001, Fujian, China.,Fujian Provincial Special Reserve Talents Laboratory, Fuzhou, 350001, Fujian, China
| | - Jun Xiao
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001, Fujian, China.,Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fujian Province University, Fuzhou, 350001, Fujian, China.,Fujian Provincial Special Reserve Talents Laboratory, Fuzhou, 350001, Fujian, China
| | - Qingsong Wu
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001, Fujian, China.,Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fujian Province University, Fuzhou, 350001, Fujian, China.,Fujian Provincial Special Reserve Talents Laboratory, Fuzhou, 350001, Fujian, China
| | - Tianci Chai
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001, Fujian, China.,Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fujian Province University, Fuzhou, 350001, Fujian, China.,Fujian Provincial Special Reserve Talents Laboratory, Fuzhou, 350001, Fujian, China
| | - Li Zhang
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Fujian Medical University, Fuzhou, China
| | - Yumei Li
- Department of Toxicology, Fujian Center for Evaluation of New Drug, Fujian Medical University, Fuzhou, China
| | - Liangwan Chen
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001, Fujian, China. .,Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fujian Province University, Fuzhou, 350001, Fujian, China. .,Fujian Provincial Special Reserve Talents Laboratory, Fuzhou, 350001, Fujian, China.
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Ji Q, Wang Y, Liu F, Yang Y, Li J, Sun X, Yang Z, Pan S, Lai H, Wang C. Mini-Invasive Bentall Procedure Performed via a Right Anterior Thoracotomy Approach With a Costochondral Cartilage Sparing. Front Cardiovasc Med 2022; 9:841472. [PMID: 35310990 PMCID: PMC8924284 DOI: 10.3389/fcvm.2022.841472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/08/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives A right minithoracotomy approach with a sternal sparing technique is a minimally invasive option for surgeons performing aortic root surgery. This report presents our initial clinical results of the right minithoracotomy Bentall procedure. Methods Clinical data of 15 patients were retrospectively analyzed who underwent the minimally invasive Bentall procedure through the right anterior thoracotomy via the second intercostal incision without any costochondral cartilage invasion at our institution between October, 2019 and June, 2021. The operative time, length of intensive care unit stay and postoperative hospital stay, perioperative outcomes, and follow-up results were analyzed. Results The median aortic cross-clamping time was 95.0 (85.5–98.8) min. Three (21.4%) patients received blood transfusion. The median drainage volume in the first 24 h was 200.0 ml, with no redo for bleeding. The median duration of mechanical ventilation was 12.5 (11.0–25.0) h, and median length of intensive care unit stay was 1.5 (1.0–3.0) day. All patients discharged 5.8 ± 1.2 days following surgery, with no dead patients found. At 6 months following surgery, all patients survived with an improved New York Heart Association (NYHA) functional class. Conclusion The right minithoracotomy Bentall procedure may be performed safely with low morbidity and mortality. This approach should be considered as an option in carefully selected patients requiring aortic root replacement.
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Affiliation(s)
- Qiang Ji
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - YuLin Wang
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - FangYu Liu
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ye Yang
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jun Li
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - XiaoNing Sun
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - ZhaoHua Yang
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Sun Pan
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hao Lai
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- *Correspondence: Hao Lai,
| | - ChunSheng Wang
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Municipal Institute for Cardiovascular Diseases, Shanghai, China
- ChunSheng Wang,
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Staromłyński J, Kowalewski M, Sarnowski W, Smoczyński R, Witkowska A, Bartczak M, Drobiński D, Wierzba W, Suwalski P. Midterm results of less invasive approach to ascending aorta and aortic root surgery. J Thorac Dis 2020; 12:6446-6457. [PMID: 33282347 PMCID: PMC7711423 DOI: 10.21037/jtd-20-2165] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Minimally invasive aortic valve (AV) surgery has become widely accepted alternative to standard sternotomy. Despite possible reduction in morbidity, this approach is not routinely performed for aortic surgery. Current report aimed to demonstrate early and mid-term outcomes in patients undergoing minimally invasive aortic root- and ascending aorta-replacement with or without concomitant AV replacement (AVR). Methods Between 2011 and 2018, 167 selected low- and intermediate risk patients (mean age: 64.1±11.3; 70% men; EuroSCORE II 2.58±3.26) underwent minimally invasive aortic surgery. The “V” shaped partial upper sternotomy was performed through a 6-cm skin incision. Patients were divided into minimally invasive root reimplantation/replacement/remodelling (root RRR), supracoronary aorta replacements (SCAR) and SCAR+AVR. Kaplan-Meier estimates of survival were used. Results Mean follow-up was 3.1 year (max 7.7 years). Of 167 patients, 82 (49%) underwent SCAR; 44 (26%) SCAR + AVR. Forty-one patients (25%) underwent minimally invasive root RRR. Average aortic diameter was 6.00±0.46 cm. The cardiopulmonary bypass and aortic cross-clamp time were 152.0±46.8 and 101.8±36.8 minutes. There was one conversion to sternotomy. Median intensive care unit stay was 2.0 (IQR: 1.0–3.0) days. Thirty-day mortality was 1%. Within investigated follow-up, there was one late reoperation due to aortic valve thrombosis; late survival was estimated at 95% without differences between types of surgery: hazard ratio, 0.81; 95% CI: 0.36–1.81; P=0.61. Conclusions Minimally invasive aortic surgery performed through “V” shaped partial upper sternotomy is feasible and safe in selected patients regardless of the extent of repair, from supracoronary aorta replacements to complex root surgery.
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Affiliation(s)
- Jakub Staromłyński
- Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Mariusz Kowalewski
- Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, Warsaw, Poland.,Thoracic Research Centre, Collegium Medicum, Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland.,Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Wojciech Sarnowski
- Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Radosław Smoczyński
- Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Anna Witkowska
- Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Maciej Bartczak
- Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Dominik Drobiński
- Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Waldemar Wierzba
- Satellite Campus in Warsaw, University of Humanities and Economics in Łódź, Warsaw, Poland
| | - Piotr Suwalski
- Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, Warsaw, Poland
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Elghannam M, Aljabery Y, Naraghi H, Moustafine V, Bechte M, Strauch J, Haldenwang P. Minimally invasive aortic root surgery: Midterm results in a 2-year follow-up. J Card Surg 2020; 35:1484-1491. [PMID: 32445199 DOI: 10.1111/jocs.14628] [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] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Minimally invasive surgery (MIS) via partial upper sternotomy (PUS) for aortic root surgery represents an alternative to the full median sternotomy (FMS). PUS offers less operative trauma. We analyzed the midterm outcome of root replacement (Bentall) or valve-sparing root replacement (David) via PUS to evaluate the safety of this access. METHODS Between November 2011 to April 2017, a total of 47 consecutive patients underwent aortic root surgery with aortic aneurysm and/or localized aortic dissection through Bentall or David operation through PUS mean age (57.9 ± 10.5 years). Bentall operation was performed in 36 patients (77%), whereas 11 patients (23%) received a David procedure. The outcome was carried out in 6-months, 1-year, and 2-years-follow up. RESULTS Mean operation time was 287.3 ± 72.6 minutes, mean cardiopulmonary bypass (CPB) time 174 ± 54.8 minutes, mean cross-clamp time 133 ± 33.1 minutes. Rethoracotomy-rate was (4.2%). Superficial wound healing disturbance was (2%) and no deep sternal infection or sternum instability occurred. Hospitalization-and intensive care unit-stay was 11.8 ± 4.4 and 1.9 ± 1.3 days with a total median ventilation-time of 10 (IQR 7.5-13.5) hours. There was no 30-day-mortality. After 2 years the total rate of mortality, major adverse cardiac and cerebrovascular events, and redo surgery was (6.3%, 4.2%, and 4.2%). CONCLUSIONS Minimally invasive aortic root surgery via partial upper sternotomy could be a safe alternative to the full median sternotomy. It requires longer operative times but reduces postoperative morbidity with good postoperative outcome.
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Affiliation(s)
- Mahmoud Elghannam
- Department of Cardiothoracic Surgery, BG University Hospital Bergmannsheil, Ruhr-University of Bochum, Bochum, Germany
| | - Yazan Aljabery
- Department of Cardiothoracic Surgery, BG University Hospital Bergmannsheil, Ruhr-University of Bochum, Bochum, Germany
| | - Hamid Naraghi
- Department of Cardiothoracic Surgery, BG University Hospital Bergmannsheil, Ruhr-University of Bochum, Bochum, Germany
| | - Vadim Moustafine
- Department of Cardiothoracic Surgery, BG University Hospital Bergmannsheil, Ruhr-University of Bochum, Bochum, Germany
| | - Matthias Bechte
- Department of Cardiothoracic Surgery, BG University Hospital Bergmannsheil, Ruhr-University of Bochum, Bochum, Germany
| | - Justus Strauch
- Department of Cardiothoracic Surgery, BG University Hospital Bergmannsheil, Ruhr-University of Bochum, Bochum, Germany
| | - Peter Haldenwang
- Department of Cardiothoracic Surgery, BG University Hospital Bergmannsheil, Ruhr-University of Bochum, Bochum, Germany
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Wu Y, Jiang W, Li D, Chen L, Ye W, Ren C, Xiao C. Surgery of ascending aorta with complex procedures for aortic dissection through upper mini-sternotomy versus conventional sternotomy. J Cardiothorac Surg 2020; 15:57. [PMID: 32264907 PMCID: PMC7140324 DOI: 10.1186/s13019-020-01095-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 03/23/2020] [Indexed: 01/28/2023] Open
Abstract
Background Use of minimally invasive approaches for isolated aortic valve or ascending aorta surgery is increasing. However, total arch replacement or aortic root repair through a minimally invasive incision is rare. This study was performed to report our initial experience with surgery of the ascending aorta with complex procedures through an upper mini-sternotomy approach. Methods We retrospectively analyzed 80 patients who underwent ascending aorta replacement combined with complex procedures including hemi-arch, total arch, and aortic root surgeries from September 2010 to May 2018. Using standard propensity score-matching analysis, 36 patients were matched and divided into 2 groups: the upper mini-sternotomy group (n = 18) and the median sternotomy group (n = 18). The preoperative assessment revealed no statistically significant differences between the two groups. Results Hospital mortality occurred in one patient (2.8%). The mini-sternotomy group showed a longer cross-clamping time (160 ± 38 vs. 135 ± 36 min, p = 0.048) due to higher rate of valve-sparing aortic root replacement and total arch repair. The cardiopulmonary bypass time in mini-sternotomy group was shorter than that of full sternotomy group (209 ± 47 min vs 218 ± 62 min, p = 0.595) but fell short of significance. There was no significant difference in lower body hypothermia circulatory arrest time between the two groups (40 ± 10 min vs 48 ± 20 min, p = 0.139). The upper mini-sternotomy group displayed a shorter ventilation time (22 vs. 45 h, p = 0.014), intensive care unit stay (4.6 ± 2.7 vs. 7.9 ± 3.7 days, p = 0.005), and hospital stay (8.2 ± 3.8 vs. 21.4 ± 11.9 days, p = 0.001). The upper mini-sternotomy group showed a lower postoperative red blood cell transfusion volume (4.6 ± 3.3 vs. 6.7 ± 5.7 units, p = 0.042) and postoperative drainage volume (764 ± 549 vs. 1255 ± 745 ml, p = 0.034). The rates of dialysis for newly occurring renal failure, neurological complications, and re-exploration were similar between the two groups (p = 1.000). Conclusion The upper mini-sternotomy approach is safe and beneficial in ascending aorta surgery with complex procedures for aortic dissection, including total arch replacement and aortic root repair.
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Affiliation(s)
- Yang Wu
- Department of Cardiovascular Surgery, PLA General Hospital, 28 Fuxing Road, Beijing, China
| | - Wei Jiang
- Department of Cardiovascular Surgery, PLA General Hospital, 28 Fuxing Road, Beijing, China
| | - Dong Li
- Department of Cardiovascular Surgery, PLA General Hospital, 28 Fuxing Road, Beijing, China
| | - Lei Chen
- Department of Cardiovascular Surgery, PLA General Hospital, 28 Fuxing Road, Beijing, China
| | - Weihua Ye
- Department of Cardiovascular Surgery, PLA General Hospital, 28 Fuxing Road, Beijing, China
| | - Chonglei Ren
- Department of Cardiovascular Surgery, PLA General Hospital, 28 Fuxing Road, Beijing, China
| | - Cangsong Xiao
- Department of Cardiovascular Surgery, PLA General Hospital, 28 Fuxing Road, Beijing, China.
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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
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Iba Y, Yamada A, Kurimoto Y, Hatta E, Maruyama R, Miura S. Perioperative Outcomes of Minimally Invasive Aortic Arch Reconstruction with Branched Grafts Through a Partial Upper Sternotomy. Ann Vasc Surg 2019; 65:217-223. [PMID: 31678130 DOI: 10.1016/j.avsg.2019.10.078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/14/2019] [Accepted: 10/14/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Ministernotomy has been advocated over recent years as an alternative technique for different cardiovascular surgical procedures to reduce the surgical trauma associated with conventional full sternotomy. In recent years, several reports have addressed minimally invasive approaches to the proximal aorta and aortic arch through a partial upper sternotomy (PUS). We reviewed our experience of minimally invasive open aortic arch reconstruction with a branched graft through a PUS. METHODS Between February 2016 and December 2018, 22 patients underwent open arch repair through a PUS. Moderate hypothermic circulatory arrest and antegrade selective cerebral perfusion were used for organ protection. The median patient age was 76 years (range, 65-86). Renal insufficiency was observed in 14 patients (64%) and chronic lung disease, in 11 (50%). Total arch replacement was performed in 20 patients (91%), while the remaining 2 (9%) received partial arch replacement with reconstruction of two supraaortic vessels. Aortic valve replacement with a tissue valve or aortic valve repair was each performed concomitantly in one patient (5%) as a concomitant procedure. The median durations of cardiopulmonary bypass, aortic cross-clamping, and circulatory arrest were 214, 109, and 50 min, respectively. RESULTS No early deaths, permanent neurological deficits, or spinal cord injuries occurred. One patient (5%) required intraoperative conversion to full sternotomy because of bleeding caused by a venting cannula injury. Three patients (14%) required re-exploration because of bleeding. Prolonged ventilation occurred in 2 patients (9%) with severe chronic obstructive pulmonary disease. CONCLUSIONS Minimally invasive aortic arch reconstruction with branched grafts through a PUS can be safely performed with satisfactory perioperative outcomes.
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Affiliation(s)
- Yutaka Iba
- Department of Cardiovascular Surgery, Teine Keijinkai Hospital, 1-40 1-12 Maeda, Teine-ku, Sapporo, Hokkaido, Japan.
| | - Akira Yamada
- Department of Cardiovascular Surgery, Teine Keijinkai Hospital, 1-40 1-12 Maeda, Teine-ku, Sapporo, Hokkaido, Japan
| | - Yoshihiko Kurimoto
- Department of Cardiovascular Surgery, Teine Keijinkai Hospital, 1-40 1-12 Maeda, Teine-ku, Sapporo, Hokkaido, Japan
| | - Eiichiro Hatta
- Department of Cardiovascular Surgery, Teine Keijinkai Hospital, 1-40 1-12 Maeda, Teine-ku, Sapporo, Hokkaido, Japan
| | - Ryushi Maruyama
- Department of Cardiovascular Surgery, Teine Keijinkai Hospital, 1-40 1-12 Maeda, Teine-ku, Sapporo, Hokkaido, Japan
| | - Shuhei Miura
- Department of Cardiovascular Surgery, Teine Keijinkai Hospital, 1-40 1-12 Maeda, Teine-ku, Sapporo, Hokkaido, Japan
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Boldyrev SY, Kaleda VI, Efremenko YV, Barbukhatti KO, Porkhanov VA. [Minimally invasive ascending aortic replacement in patient with chronic aortic dissection type A (in Russian only)]. Khirurgiia (Mosk) 2019:80-83. [PMID: 30938361 DOI: 10.17116/hirurgia201903180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
It is presented case report of minimally invasive surgical repair of chronic aortic dissection type A in a 61-year-old patient. Perspective minimally invasive surgical approach is suggested for this pathology in order to improve quality of life and rehabilitation after cardiac surgery. Surgical technique and features are comprehensively described.
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Affiliation(s)
- S Yu Boldyrev
- Research Institute 'Ochapovsky Regional Clinical Hospital #1', Krasnodar, Russia
| | - V I Kaleda
- Research Institute 'Ochapovsky Regional Clinical Hospital #1', Krasnodar, Russia
| | - Yu V Efremenko
- Research Institute 'Ochapovsky Regional Clinical Hospital #1', Krasnodar, Russia
| | - K O Barbukhatti
- Research Institute 'Ochapovsky Regional Clinical Hospital #1', Krasnodar, Russia
| | - V A Porkhanov
- Research Institute 'Ochapovsky Regional Clinical Hospital #1', Krasnodar, Russia
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Akbulut M, Arslan O, Ak A, Tas S, Cekmecelioglu D, Sismanoglu M, Tuncer A. Innominate vein cannulation: easy but neglected technique. J Cardiovasc Thorac Res 2019; 10:187-191. [PMID: 30680075 PMCID: PMC6335992 DOI: 10.15171/jcvtr.2018.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 11/19/2018] [Indexed: 11/15/2022] Open
Abstract
Introduction: Our experience in minimally invasive procedures and improvement of graft
technology enables easy and successful operation carried out even with complex thoracic aortic
diseases from limited surgical area. However, it should be more than one incision or cannulation
site for such intervention. We aimed to present our experience and results of 23 patients who
has ascending aorta and aortic arch pathologies of which we operated with J-shaped partial
sternotomy and innominate vein cannulation.
Methods: From January 2014 to January 2016, 23 patients with aorta and aortic valve pathologies
who underwent aortic surgery with J-shaped partial sternotomy and innominate vein cannulation
included. Operation findings, cardiopulmonary bypass (CPB) values, postoperative results,
surgical mortality and morbidity rates, late conversion to full sternotomy rates, ICU and hospital
length of stay were evaluated.
Results: The mean age of the patients was 53.7±12 (range 19-68) and 18 (78.2%) were males.
Arcus aorta debranching applied to 4 patients (17.3%) and one of these procedures was frozen
elephant trunk procedure (4.3%). Neither mortality nor cerebrovascular accident occurred. Mean
CPB peak flow was 4.6±0.4 L/min, mean flow index calculated as 2.01±0.38 L/min/m2 and there
was no CPB problem intraoperatively. Innominate vein ligation was carried out in 5 patients but
no complication was seen except one who had left arm swelling treated with elevation.
Conclusion: Innominate vein cannulation with J-shaped partial sternotomy is a reliable and easily
applicable method providing effective utilization of limited operative field not only in ascending
aorta and aortic arch operations but also with the advancements of hybrid systems used in
descending aorta pathologies.
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Affiliation(s)
- Mustafa Akbulut
- Kosuyolu Kartal Heart Training and Research Hospital, Department of Cardiovascular Surgery, Istanbul, Turkey
| | - Ozgur Arslan
- Kosuyolu Kartal Heart Training and Research Hospital, Department of Cardiovascular Surgery, Istanbul, Turkey
| | - Adnan Ak
- Kosuyolu Kartal Heart Training and Research Hospital, Department of Cardiovascular Surgery, Istanbul, Turkey
| | - Serpil Tas
- Kosuyolu Kartal Heart Training and Research Hospital, Department of Cardiovascular Surgery, Istanbul, Turkey
| | - Davut Cekmecelioglu
- Kosuyolu Kartal Heart Training and Research Hospital, Department of Cardiovascular Surgery, Istanbul, Turkey
| | - Mesut Sismanoglu
- Kosuyolu Kartal Heart Training and Research Hospital, Department of Cardiovascular Surgery, Istanbul, Turkey
| | - Altug Tuncer
- Kosuyolu Kartal Heart Training and Research Hospital, Department of Cardiovascular Surgery, Istanbul, Turkey
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Nešpor D, Ondrášek J, Štěrba J, Kára T, Němec P. Our experience with surgical minimally invasive aortic valve replacement. COR ET VASA 2018. [DOI: 10.1016/j.crvasa.2017.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Current Trends in Aortic Root Surgery: The Mini-Bentall Approach. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2018; 13:91-96. [PMID: 29683812 DOI: 10.1097/imi.0000000000000476] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The mini-sternotomy approach is becoming a widespread technique for aortic valve surgery. However, its safety for aortic root replacement has yet to be established. The aim of the present study was to compare the operative outcomes of patients who underwent aortic root replacement via upper mini-sternotomy (mini-Bentall) to patients who underwent Bentall procedure via median sternotomy (full-sternotomy Bentall). METHODS Between November 1998 and November 2016, 91 consecutive patients underwent full-sternotomy Bentall procedure and 26 patients underwent mini-Bentall procedure. The mini-Bentall procedure was performed via an upper hemisternotomy incision extending to the right fourth intercostal space. Patients with concomitant procedures and those who underwent deep hypothermic circulatory arrest were excluded from the analysis. Outcome variables were operative mortality and major surgical complications, including prolonged length of hospital stay, transfusion rates, reoperation for bleeding, and prolonged ventilatory support. RESULTS No significant differences were observed on the preoperative, operative, and postoperative characteristics between the two treatment groups. The median cardiopulmonary bypass and aortic cross-clamp times were 169 minutes (interquartile range = 156.0-188.5) and 148 minutes (interquartile range = 131.3-160.3) in the mini-Bentall group, respectively. The median duration of hospitalization in the mini-Bentall group was 6.5 days (interquartile range = 5.0-11.0 days). In-hospital mortality and new renal insufficiency occurred at a frequency of 1.1% and reoperation for bleeding at 6.6% in the group of patients who underwent the conventional Bentall procedure compared with 0% for all these measures in the mini-Bentall group (P > 0.33). There was no significant difference in intraoperative red blood cell transfusion and other major postoperative complications. No strokes were observed in either group, and there were no conversions to median sternotomy in the mini-Bentall group. CONCLUSIONS An upper hemisternotomy is a feasible technique in patients undergoing elective aortic root replacement surgery. However, future prospective studies are required before these procedures become the standard of care.
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Elattar MA, Kaya A, Planken NR, Baan J, Vanbavel ET, de Mol BAJM, Marquering HA. A computed tomography-based planning tool for predicting difficulty of minimally invasive aortic valve replacement. Interact Cardiovasc Thorac Surg 2018; 27:505-511. [PMID: 29659843 DOI: 10.1093/icvts/ivy128] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 03/21/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Minimally invasive aortic valve replacement has proven its value over the last decade by its significant advancement and reduction in mortality, morbidity and admission time. However, minimally invasive aortic valve replacement is associated with some on-site difficulties such as limited aortic annulus exposure. Currently, computed tomography scans are used to evaluate the anatomical relationship among the intercostal spaces, ascending aorta and aortic valve prior to surgery. We hypothesized that quantitative measurements of access distance and access angle are associated with outcome and access difficulty. METHODS We introduce a novel minimally invasive aortic valve replacement planning prototype that allows automatic measurements of access angle, access distance and aortic annulus dimensions. The prototype visualizes these measurements on the chest cage as ISO contours. The association of these measures with outcome parameters such as extracorporeal circulation time, aortic cross-clamping time and access difficulty score was assessed. We included 14 patients who received a new valve by ministernotomy. RESULTS The mean access angle was 40.3 ± 5.1°. It was strongly associated with aortic cross-clamping time (Pearson correlation coefficient = 0.60, P = 0.02) and access difficulty score (Spearman's rank correlation coefficient = 0.57, P = 0.03). Access angles were significantly different between easy and difficult access groups (P = 0.03). There was no significant association between access distance and outcome parameters. CONCLUSIONS Access angle is strongly associated with procedure complexity. The automated presentation of this measure suggests added value of the prototype in clinical practice.
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Affiliation(s)
- Mustafa A Elattar
- Department of Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.,Department of Informatics Science, Communication and Information Technology School, Nile University, Giza, Egypt
| | - Abdullah Kaya
- Department of Cardiothoracic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Nils R Planken
- Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Jan Baan
- Department of Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Ed T Vanbavel
- Department of Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Bas A J M de Mol
- Department of Cardiothoracic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.,Department of Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Henk A Marquering
- Department of Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.,Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
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Right Mini-thoracotomy Bentall Procedure. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2018; 13:328-331. [DOI: 10.1097/imi.0000000000000555] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objective Bentall procedures are traditionally performed through a median sternotomy. The right mini-thoracotomy approach is increasingly used in aortic valve replacement. This approach has been shown to have decreased blood loss and hospital length of stay compared with sternotomy. A right mini-thoracotomy approach may also be beneficial in selected patients requiring aortic root surgery. We present our initial clinical experience of patients who have undergone a right mini-thoracotomy Bentall. Methods This is a single-center retrospective review of seven patients who underwent a primary elective right anterior mini-thoracotomy Bentall. A thoracoscope was used in each case. Automated suturing technology was used for annular suturing in three of the seven patients. Clinical outcomes evaluated include 30-day mortality, intensive care and hospital length of stay, time to extubation, operative times, as well as postoperative sequelae including stroke, infection, and bleeding. Results Median cardiopulmonary bypass, cross-clamp, and circulatory arrest time were 217, 153, and 28 minutes, respectively. Median time to extubation was 10 hours and median intensive care unit and hospital stay was 1 and 4 days, respectively. One patient had a wound infection and one returned to the operating room for bleeding. There were no in-hospital or 30-day mortalities. Conclusions The Bentall procedure can be performed through a right anterior mini-thoracotomy in selected patients with excellent clinical results.
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Mansukhani NA, Miller KR, Havelka GE, Russell HM, Eskandari MK. Aorta-innominate bypass through ministernotomy. J Vasc Surg 2018; 68:607-610. [DOI: 10.1016/j.jvs.2018.01.069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 01/16/2018] [Indexed: 10/28/2022]
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Early results of total arch replacement under partial sternotomy. Gen Thorac Cardiovasc Surg 2018; 66:327-333. [PMID: 29600320 DOI: 10.1007/s11748-018-0913-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 03/26/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Partial sternotomy with limited skin incision has been utilized for cardiac surgery. We, therefore, started to apply the partial sternotomy for total arch replacement since 2013 in selected cases. The aim of this study reported the results of our early experiences. METHODS Between July 2013 and December 2015, we retrospectively reviewed 15 cases (median age 72, range 67-84, 15 male) who underwent total arch replacement thorough partial sternotomy. All procedures were performed under hypothermic circulatory arrest with selective cerebral perfusion. RESULTS Median skin incision was 9 cm (range 7-15 cm, 5.3% of height) and partial sternotomy consisted of 14 upper and 1 lower partial sternotomy (L shape 8 and T shape 7 cases). Median operation time, cardiopulmonary bypass time, ischemic heart time, selective cerebral perfusion time and hypothermic circulatory arrest time were 485 [360-770], 223 [1174-270], 146 [100-163], 154 [116-189], and 69 [45-90] minutes, respectively. Median duration of mechanical ventilator dependent time was 12 h [5-38]. Median length of ICU stay and hospital stay were 3 [1-7], and 18 [13-76] days, respectively. Thirty days and in-hospital mortality were 0% without any neurological complications. There are two aorta-related reoperation due to graft inducing hemolytic anemia and no aorta-related death during follow-up (median 954, range 702-1462 days). CONCLUSION The early results of total arch replacement through partial sternotomy were satisfactory. The partial sternotomy could be a good option for total arch replacement in selected patients.
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Abjigitova D, Panagopoulos G, Orlov O, Shah V, Plestis KA. Current Trends in Aortic Root Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2018. [DOI: 10.1177/155698451801300203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Djamila Abjigitova
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Cardiothoracic Surgery, Lankenau Medical Center, Wynnewood, PA USA
| | - Georgia Panagopoulos
- Department of Cardiothoracic Surgery, Lankenau Medical Center, Wynnewood, PA USA
| | - Oleg Orlov
- Department of Cardiothoracic Surgery, Lankenau Medical Center, Wynnewood, PA USA
| | - Vishal Shah
- Department of Cardiothoracic Surgery, Lankenau Medical Center, Wynnewood, PA USA
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Mini-Bentall: An Interesting Approach for Selected Patients. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017; 12:41-45. [PMID: 28129319 DOI: 10.1097/imi.0000000000000337] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Minimally invasive surgery through an upper hemisternotomy for aortic valve replacement has become the routine approach with excellent results. Actually, the same minimally invasive access is used for complex ascending aorta procedures only in few centers. We report our experience with minimally invasive approach for aortic valve and ascending aorta replacement using Bentall technique. METHODS From January 2010 to November 2015, a total of 238 patients received ascending aorta and aortic valve replacement using Bentall De Bono procedure at our institution. Low- and intermediate-risk patients underwent elective surgery with a minimally invasive approach. The "J"-shaped partial upper sternotomy was performed through a 6-cm skin incision from the notch to the third right intercostal space. Patients who had previous cardiac surgery or affected by active endocarditis were excluded. The study included 53 patients, 44 male (83 %) with a median age of 63 years [interquartile range (IQR), 51-73 years]. A bicuspid aortic valve was diagnosed in 27 patients (51%). RESULTS A biological Bentall using a pericardial Mitroflow or Crown bioprosthesis implanted in a Valsalva graft was performed in 49 patents. The remaining four patients were treated with a traditional mechanical conduit. Median cardiopulmonary bypass time and median cross-clamp time were respectively 84 (IQR, 75-103) minutes and 73 (IQR, 64-89) minutes. Hospital mortality was zero as well as 30-day mortality. Median intensive care unit and hospital stay were 1.9 and 8 days, respectively. The study population compared with patients treated with standard full sternotomy and similar preoperative characteristics showed similar results in terms of postoperative outcomes with a slightly superiority of minimally invasive group mainly regarding operative times, incidence of atrial fibrillation, and postoperative ventilation times. CONCLUSIONS A partial upper sternotomy is considered a safe option for aortic valve replacement. Our experience confirms that a minimally invasive approach using a partial upper J-shaped sternotomy can be a safe alternative approach to the standard in selected patients presenting with complex aortic root pathology.
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Outcomes of a Less-Invasive Approach for Proximal Aortic Operations. Ann Thorac Surg 2017; 103:533-540. [DOI: 10.1016/j.athoracsur.2016.06.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 05/23/2016] [Accepted: 06/06/2016] [Indexed: 11/23/2022]
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Mikus E, Micari A, Calvi S, Salomone M, Panzavolta M, Paris M, Del Giglio M. Mini-Bentall: An Interesting Approach for Selected Patients. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017. [DOI: 10.1177/155698451701200108] [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)
- Elisa Mikus
- Departments of Cardiovascular Surgery, Cotignola, Ravenna, Italy
| | - Antonio Micari
- Cardiology, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Ravenna, Italy
| | - Simone Calvi
- Departments of Cardiovascular Surgery, Cotignola, Ravenna, Italy
| | | | - Marco Panzavolta
- Departments of Cardiovascular Surgery, Cotignola, Ravenna, Italy
| | - Marco Paris
- Departments of Cardiovascular Surgery, Cotignola, Ravenna, Italy
| | - Mauro Del Giglio
- Departments of Cardiovascular Surgery, Cotignola, Ravenna, Italy
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Elattar MA, van Kesteren F, Wiegerinck EM, Vanbavel E, Baan J, Cocchieri R, de Mol B, Planken NR, Marquering HA. Automated CTA based measurements for planning support of minimally invasive aortic valve replacement surgery. Med Eng Phys 2016; 39:123-128. [PMID: 27913175 DOI: 10.1016/j.medengphy.2016.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 11/03/2016] [Accepted: 11/14/2016] [Indexed: 11/27/2022]
Abstract
Minimally invasive aortic valve replacement (mini-AVR) procedures are a valuable alternative to conventional open heart surgery. Currently, planning of mini-AVR consists of selection of the intercostal space closest to the sinotubular junction on preoperative computer tomography images. We developed an automated algorithm detecting the sinotubular junction (STJ) and intercostal spaces for finding the optimal incision location. The accuracy of the STJ detection was assessed by comparison with manual delineation by measuring the Euclidean distance between the manually and automatically detected points. In all 20 patients, the intercostal spaces were accurately detected. The median distance between automated and manually detected STJ locations was 1.4 [IQR= 0.91-4.7] mm compared to the interobserver variation of 1.0 [IQR= 0.54-1.3] mm. For 60% of patients, the fourth intercostal space was the closest to the STJ. The proposed algorithm is the first automated approach for detecting optimal incision location and has the potential to be implemented in clinical practice for planning of various mini-AVR procedures.
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Affiliation(s)
- Mustafa A Elattar
- Department of Biomedical Engineering and Physics, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - Floortje van Kesteren
- Departments of Radiology, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; Department of Heart Center, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Esther M Wiegerinck
- Department of Heart Center, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Ed Vanbavel
- Department of Biomedical Engineering and Physics, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Jan Baan
- Department of Heart Center, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Riccardo Cocchieri
- Department of Heart Center, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Bas de Mol
- Department of Heart Center, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Nils R Planken
- Departments of Radiology, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Henk A Marquering
- Department of Biomedical Engineering and Physics, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; Departments of Radiology, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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Ziyaeifard M, Alizadehasl A, Aghdaii N, Rahimzadeh P, Masoumi G, Golzari SE, Fatahi M, Gorjipur F. The effect of combined conventional and modified ultrafiltration on mechanical ventilation and hemodynamic changes in congenital heart surgery. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2016; 21:113. [PMID: 28255321 PMCID: PMC5331766 DOI: 10.4103/1735-1995.193504] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Revised: 06/29/2016] [Accepted: 08/20/2016] [Indexed: 11/06/2022]
Abstract
Background: Cardiopulmonary bypass is associated with increased fluid accumulation around the heart which influences pulmonary and cardiac diastolic function. The aim of this study was to compare the effects of modified ultrafiltration (MUF) versus conventional ultrafiltration (CUF) on duration of mechanical ventilation and hemodynamic status in children undergoing congenital heart surgery. Materials and Methods: A randomized clinical trial was conducted on 46 pediatric patients undergoing cardiopulmonary bypass throughout their congenital heart surgery. Arteriovenous MUF plus CUF was performed in 23 patients (intervention group) and sole CUF was performed for other 23 patients (control group). In MUF group, arterial cannula was linked to the filter inlet through the arterial line, and for 10 min, 10 ml/kg/min of blood was filtered and returned via cardioplegia line to the right atrium. Different parameters including hemodynamic variables, length of mechanical ventilation, Intensive Care Unit (ICU) stay, and inotrope requirement were compared between the two groups. Results: At immediate post-MUF phase, there was a statistically significant increase in the mean arterial pressure, systolic blood pressure, and diastolic blood pressure (P < 0.05) only in the study group. Furthermore, there was a significant difference in time of mechanical ventilation (P = 0.004) and ICU stay (P = 0.007) between the two groups. Inotropes including milrinone (P = 0.04), epinephrine (P = 0.001), and dobutamine (P = 0.002) were used significantly less frequently for patients in the intervention than the control group. Conclusion: Administration of MUF following surgery improves hemodynamic status of patients and also significantly decreases the duration of mechanical ventilation and inotrope requirement within 48 h after surgery.
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Affiliation(s)
- Mohsen Ziyaeifard
- Department of Cardiac Anesthesiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Azin Alizadehasl
- Department of Cardiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Nahid Aghdaii
- Department of Cardiac Anesthesiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Poupak Rahimzadeh
- Department of Anesthesiology and Pain Medicine, Hazrat Rasul Medical Complex, Iran University of Medical Sciences, Tehran, Iran
| | - Gholamreza Masoumi
- Department of Anesthesiology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Samad Ej Golzari
- Department of Anesthesiology and Intensive Care Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mostafa Fatahi
- Department of Perfusion, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Farhad Gorjipur
- Department of Perfusion, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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Lamelas J, LaPietra A. Right Minithoracotomy Approach for Replacement of the Ascending Aorta, Hemiarch, and Aortic Valve. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2016. [DOI: 10.1177/155698451601100414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Joseph Lamelas
- Division of Cardiac Surgery at the Mount Sinai Heart Institute, Miami Beach, FL USA
| | - Angelo LaPietra
- Division of Cardiac Surgery at the Mount Sinai Heart Institute, Miami Beach, FL USA
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30
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Right Minithoracotomy Approach for Replacement of the Ascending Aorta, Hemiarch, and Aortic Valve. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2016; 11:301-4. [DOI: 10.1097/imi.0000000000000292] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A minimally invasive right anterior thoracotomy approach is the preferred technique used at our institution for isolated aortic valve pathology. We have recently introduced more complex concomitant minimally invasive procedures through this access site. Here, we describe how we perform a replacement of the ascending aorta and aortic valve with and without the use of circulatory arrest through a 6-cm right minimally invasive thoracotomy incision.
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El-Sayed Ahmad A, Risteski P, Papadopoulos N, Radwan M, Moritz A, Zierer A. Minimally invasive approach for aortic arch surgery employing the frozen elephant trunk technique. Eur J Cardiothorac Surg 2016; 50:140-4. [DOI: 10.1093/ejcts/ezv484] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 12/04/2015] [Indexed: 11/14/2022] Open
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Lentini S, Specchia L, Nicolardi S, Mangia F, Rasovic O, Di Eusanio G, Gregorini R. Surgery of the Ascending Aorta with or without Combined Procedures through an Upper Ministernotomy: Outcomes of a Series of More Than 100 Patients. Ann Thorac Cardiovasc Surg 2015; 22:44-8. [PMID: 26567880 DOI: 10.5761/atcs.oa.15-00245] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Use of a minimally invasive approach for isolated aortic valve surgery is increasing. However, management of the root and/or ascending aorta through a mini-invasive incision is not so frequent. The aim of this study is to report our initial experience with surgery of the ascending aorta through a ministernotomy approach. METHODS We retrospectively analyzed 102 patients treated for ascending aorta disease through a ministernotomy. Several types of surgeries were performed, including isolated or combined surgical procedures. Pre-operative and operative parameters and in-hospital clinical outcomes were retrospectively analyzed. RESULTS Patient mean age was 63.9 ± 13.6 years (range 29-85). There were 33 (32.4%) female and 69 (67.6%) male patients. Preoperative logistic EuroSCORE I was 7.4% ± 2.1%. Mean cardiopulmonary bypass and aortic cross-clamp time were 123.7 ± 36.9 and 100.8 ± 27.5 min, respectively. In-hospital mortality was 0%. CONCLUSIONS Our experience shows that surgery of the ascending aorta with or without combined procedures can be safely performed through an upper ministernotomy, without compromising surgical results. Although our series is not large, we believe that the experience gained on the isolated aortic valve through a ministernotomy can be safely reproduced in ascending aorta surgery as a routine practice.
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Affiliation(s)
- Salvatore Lentini
- Cardiac Surgery Unit, Cardiovascular Department, Città di Lecce Hospital, GVM Care & Research, Lecce, Italy
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33
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Boeken U, Minol JP, Assmann A, Mehdiani A, Akhyari P, Lichtenberg A. Readmission to the Intensive Care Unit in Times of Minimally Invasive Cardiac Surgery: Does Size Matter? Heart Surg Forum 2015; 17:E296-301. [DOI: 10.1532/hsf98.2014361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
<p><b>Objectives:</b> It is well known that patients who undergo readmission to an intensive care unit (ICU) after cardiac surgery face an increased risk of morbidity and mortality. The present study sought to evaluate whether less invasive procedures might be associated with a reduction of this economically as well as individually important problem. The role of the quantity of ICU and intermediate care (IMC) beds was investigated as well.</p><p><b>Methods:</b> Altogether, we reviewed 5,333 patients who underwent cardiac surgery in our department between 2005 and 2010. The incidence of and reasons for readmission were determined with regard to individual subgroups, particularly comparing minimally invasive procedures with conventional strategies.</p><p><b>Results:</b> A total of 5,132 patients were primarily discharged from the ICU. Out of this group, 293 patients were readmitted to the ICU at least once. After readmission, the average length of stay in the hospital was 21.9 � 11.3 days compared to 12.8 � 5.0 days in all other patients. Comparing the readmission rate in separate years, it was evident that this rate decreased with a growing ICU and IMC capacity. In patients who underwent less invasive cardiac surgery (ie, minimally invasive cardiac surgery, off-pump coronary artery bypass grafting), the readmission rates were significantly lower than in the entirety of patients studied.</p><p><b>Conclusion:</b> Readmission to the ICU after cardiac surgery is associated with impaired outcome. Extended resources in terms of ICU and IMC capacity may positively influence this problem by decreasing the number of readmissions. Modern surgical strategies with less invasive procedures may be associated with a reduced incidence of readmission as well.</p>
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Outcomes of Aortic Valve and Concomitant Ascending Aorta Replacement Performed via a Minimally Invasive Right Thoracotomy Approach. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2014; 9:339-42; discussion 342. [DOI: 10.1097/imi.0000000000000099] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objective Replacement of the aortic valve with concomitant replacement of the ascending aorta performed via a minimally invasive right anterior thoracotomy approach has not been reported. We evaluated the feasibility and safety of this procedure. Methods We retrospectively reviewed all minimally invasive aortic valve replacements (AVRs) with concomitant replacement of the ascending aorta performed at our institution between January 1, 2012, and December 30, 2012. The operative times, intensive care unit and hospital lengths of stay, postoperative outcomes, as well as mortality were analyzed. Results A total of 20 consecutive patients who underwent minimally invasive AVR with concomitant replacement of the ascending aorta were identified. There were 16 men (80%), with a mean (SD) age of 61 (13) years. The mean (SD) left ventricular ejection fraction was 58% (8%). The aortic valve was bicuspid in 18 patients (80%), with 14 (70%) being stenotic. The median aortic cross-clamp and cardiopulmonary bypass times were 163 [interquartile range (IQR), 141–170] minutes and 291 (IQR, 177–215) minutes, respectively. Hypothermic circulatory arrest was required in 19 patients (95%), with a median hypothermic circulatory arrest time of 35 (IQR, 33–39.5) minutes. The median intensive care unit and hospital lengths of stay were 24 (IQR, 23–41) hours and 5 (IQR, 4–6) days, respectively. There were no strokes, reoperations for bleeding, or conversions to sternotomy. The 30-day mortality was zero. Conclusions Minimally invasive AVR with concomitant replacement of the ascending aorta, via a right anterior thoracotomy approach, can be performed with low morbidity and mortality.
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35
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LaPietra A, Santana O, Pineda AM, Mihos CG, Lamelas J. Outcomes of Aortic Valve and Concomitant Ascending Aorta Replacement Performed via a Minimally Invasive Right Thoracotomy Approach. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2014. [DOI: 10.1177/155698451400900503] [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)
| | - Orlando Santana
- Cardiology, Columbia University, Mount Sinai Heart Institute, Miami Beach, FL USA
| | - Andrés M. Pineda
- Cardiology, Columbia University, Mount Sinai Heart Institute, Miami Beach, FL USA
| | - Christos G. Mihos
- Cardiology, Columbia University, Mount Sinai Heart Institute, Miami Beach, FL USA
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Dohmen PM, Borger MA, Misfeld M, Mohr FW. Thoracoscopic confirmation of correct seating of minimaly-invasive rapid-deployment aortic bioprosthesis. Med Sci Monit 2013; 19:773-6. [PMID: 24045538 PMCID: PMC3781200 DOI: 10.12659/msm.889094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
There is a growing interest in minimally invasive access for aortic valve surgery. The upper hemi-sternotomy provides good aortic valve exposure, with numerous possible advantages. Nevertheless, some surgeons remain skeptical about limited access surgery because it is technically more demanding. Sutureless and rapid-deployment bioprostheses could alleviate these concerns by improving ease of implantation. We herein describe the use of video-assisted visualization to verify the position of the balloon-expandable frame during rapid aortic valve deployment. Sutureless and rapid-deployment bioprostheses improve implantation and make it easy to increase minimally invasive access for aortic valve surgery.
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Affiliation(s)
- Pascal M Dohmen
- Department of Cardiac Surgery, Heart Centre Leipzig, University of Leipzig, Leipzig, Germany
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37
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Deschka H, Erler S, Machner M, El-Ayoubi L, Alken A, Wimmer-Greinecker G. Surgery of the ascending aorta, root remodelling and aortic arch surgery with circulatory arrest through partial upper sternotomy: results of 50 consecutive cases. Eur J Cardiothorac Surg 2012; 43:580-4. [PMID: 22700588 DOI: 10.1093/ejcts/ezs341] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Partial upper sternotomy is a routine approach to aortic valve surgery. For surgery of the ascending aorta or the aortic arch, this method is not well established yet. METHODS From October 2007 to October 2010, 50 consecutive patients underwent procedures of the ascending aorta and the aortic arch using partial upper sternotomy. Thirty-six patients underwent replacement or tightening of the ascending aorta, 11 patients received additional replacement of the proximal arch and in 3 cases, a complete replacement of the aortic arch was performed. Thirty-nine patients underwent additional aortic valve surgery. RESULTS Mean operation time was 249 ± 51 min. Mean aortic cross-clamp and cardiopulmonary bypass time were 95 ± 27 and 141 ± 35 min, respectively. No conversion to conventional sternotomy was performed. All valves appeared competent on postoperative echocardiography. Survival was 100%. One re-exploration for bleeding was necessary. One stroke (2%) occurred, one pacemaker was implanted due to third-degree AV block and 16 patients (32%) experienced atrial fibrillation. One patient suffered from sternal wound infection. One patient needed reoperation due to severe aortic insufficiency on postoperative day 13. Median postoperative ventilation time was 13 h, median intensive care unit (ICU) and hospital stay were 22 h and 7 days, respectively. CONCLUSIONS Results show that minimally invasive surgical procedures of the ascending aorta and the aortic arch may be performed safely, with an excellent clinical outcomes and superior cosmesis. Short ICU and hospital stay indicate the beneficial effects of reduced surgical trauma for patient recovery.
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Affiliation(s)
- Heinz Deschka
- Department of Cardiothoracic Surgery, Heart and Vessel Center Bad Bevensen, Bad Bevensen, Germany.
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38
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Lentini S, Spinelli D, Pipitò N, Massara M, Benedetto F, Spinelli F. Ministernotomy with subclavian extension for the management of a large intrathoracic pseudoaneurysm. J Card Surg 2012; 27:368-70. [PMID: 22621719 DOI: 10.1111/j.1540-8191.2012.01450.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report on the management of a large intrathoracic subclavian pseudoaneurysm treated using an upper J ministernotomy with subclavian extension. This approach allows exposure of the supraaortic vessels and upper portion of the thoracic cavity and may be of help in selected cases.
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Affiliation(s)
- Salvatore Lentini
- Cardiovascular and Thoracic Department, Policlinico G. Martino, University of Messina, Messina, Italy.
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Sartini P, Winfield A, Bizzarri F. The successful introduction of an adapted form of the mini extra corporeal circulation used for cardiac surgery in an obese patient. J Cardiothorac Surg 2012; 7:20. [PMID: 22405024 PMCID: PMC3359175 DOI: 10.1186/1749-8090-7-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Accepted: 03/09/2012] [Indexed: 11/10/2022] Open
Abstract
Obese patients undergoing cardiac surgery have been shown to have a high risk of developing postoperative complications, specifically: increased length of hospital stay, readmission to intensive care unit, acute renal failure, deep sternal wound infections and new onset of atrial fibrillation.A custom-made circuit was created to allow the use of Mini Extra Corporeal Circulation (MECC) but permitting the switch to a closed siphon drainage system in the case of difficulties.To limit artificial surface contact a small oxygenating device (Admiral, Eurosets) was employed in spite of the patients size. This adapted circuit permits a feasible and safer approach to using MECC. This report suggests that smaller oxygenators could be integrated into clinical practice in an adult MECC configuration, even for more obese patients, limiting artificial surface contact.
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Affiliation(s)
- Patrizio Sartini
- Department of Medical Surgical Sciences and Biotechnologies, Cardiac Surgery Unit, Polo Pontino, Universita' degli Studi di Roma "Sapienza", Latina, Italy
| | - Anna Winfield
- Department of Cardiac Surgery, Yorkshire Heart Centre, Leeds General Infirmary, Great George Street, LS1 7EH Leeds, UK
| | - Federico Bizzarri
- Department of Medical Surgical Sciences and Biotechnologies, Cardiac Surgery Unit, Polo Pontino, Universita' degli Studi di Roma "Sapienza", Latina, Italy
- Department of Cardiac Surgery, Yorkshire Heart Centre, Leeds General Infirmary, Great George Street, LS1 7EH Leeds, UK
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Perrotta S, Lentini S. In patients with severe active aortic valve endocarditis, is a stentless valve as good as the homograft? Interact Cardiovasc Thorac Surg 2010; 11:309-13. [DOI: 10.1510/icvts.2010.234831] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Hasegawa T, Zaima A, Hisamatsu C, Nishijima E, Okita Y. Minimally invasive innominate artery transection for tracheomalacia using 3-dimensional multidetector-row computed tomographic angiography: report of a case. J Pediatr Surg 2010; 45:E1-4. [PMID: 20638508 DOI: 10.1016/j.jpedsurg.2010.04.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Revised: 04/04/2010] [Accepted: 04/05/2010] [Indexed: 10/19/2022]
Abstract
We successfully performed transection of the innominate artery in a patient with a neuromuscular disorder through minimally invasive access after confirming the anatomical relationships of the vessel using 3-dimensional multidetector-row computed tomographic angiography. A 16-year-old girl with spinal muscular atrophy type 1 had been on long-term mechanical ventilation with a tracheostomy. She had scoliosis and tracheomalacia. Bronchoscopy showed a flattened and narrow lower trachea and an anterior pulsatile compression by the innominate artery. She underwent transection of the innominate artery to prevent tracheoinnominate artery fistula formation. Based on preoperative 3-dimensional multidetector-row computed tomographic angiography images, the innominate artery was transected through a small transverse curvilinear skin incision just below the suprasternal notch and an oblique partial manubriotomy from the suprasternal notch to the first left intercostal space.
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Affiliation(s)
- Tomomi Hasegawa
- Division of Cardiovascular and Pediatric Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan.
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