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Aston D, Zeloof D, Falter F. Anaesthesia for Minimally Invasive Cardiac Surgery. J Cardiovasc Dev Dis 2023; 10:462. [PMID: 37998520 PMCID: PMC10672390 DOI: 10.3390/jcdd10110462] [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: 10/15/2023] [Revised: 11/04/2023] [Accepted: 11/13/2023] [Indexed: 11/25/2023] Open
Abstract
Minimally invasive cardiac surgery (MICS) has been used since the 1990s and encompasses a wide range of techniques that lack full sternotomy, including valve and coronary artery graft surgery as well as transcatheter procedures. Due to the potential benefits offered to patients by MICS, these procedures are becoming more common. Unique anaesthetic knowledge and skills are required to overcome the specific challenges presented by MICS, including mastery of transoesophageal echocardiography (TOE) and the provision of thoracic regional analgesia. This review evaluates the relevance of MICS to the anaesthetist and discusses pre-operative assessment, the relevant adjustments to intra-operative conduct that are necessary for these techniques, as well as post-operative care and what is known about outcomes.
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Affiliation(s)
- Daniel Aston
- Department of Anaesthesia and Critical Care, Royal Papworth NHS Foundation Trust, Cambridge Biomedical Campus, Papworth Road, Cambridge CB2 0AY, UK; (D.Z.); (F.F.)
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Yost CC, Rosen JL, Mandel JL, Prochno KW, Wu M, Komlo CM, Guy TS. Endoaortic balloon occlusion versus transthoracic cross-clamp for totally endoscopic robotic mitral valve surgery: a retrospective cohort study. J Robot Surg 2023; 17:2305-2313. [PMID: 37340117 DOI: 10.1007/s11701-023-01654-3] [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: 03/31/2023] [Accepted: 06/11/2023] [Indexed: 06/22/2023]
Abstract
Endoaortic balloon occlusion (EABO) and transthoracic cross-clamping have been shown to have comparable safety profiles for aortic occlusion in minimally invasive mitral valve surgery (MIMVS). However, few studies have focused exclusively on the totally endoscopic robotic approach. We sought to compare outcomes for patients undergoing totally endoscopic robotic mitral valve surgery with aortic occlusion via EABO and transthoracic clamping after a period where EABO was unavailable required us to use the transthoracic clamp. Retrospective review identified 113 patients who underwent robotic mitral valve surgery at our facility between 2019 and 2021 with EABO (n = 71) or transthoracic clamping (n = 42). Relevant data were extracted and compared. Preoperative characteristics were similar other than a higher rate of coronary artery disease [EABO: 69.0% (49/71) vs clamp: 45.2% (19/42), p = .02] and chronic lung disease [EABO: 38.0% (27/71) vs clamp: 9.5% (4/42), p < .01] in the EABO group. Median percutaneous cardiopulmonary bypass time, operative time, and cross-clamp time were comparable. Similar rates of postoperative bleeding complications were observed, and no aortic complications were observed. One patient in each group underwent conversion to an open approach. 30-day mortality and readmission rates were comparable. EABO and transthoracic clamp were associated with similar bleeding and aortic outcomes, and mortality and readmission rates were comparable at thirty days postoperatively. Our findings support the comparable safety of the two techniques, which is well documented in studies encompassing all MIMVS techniques, within the specific context of the totally endoscopic robotic approach.
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Affiliation(s)
- Colin C Yost
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jake L Rosen
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jenna L Mandel
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Kyle W Prochno
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Meagan Wu
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Caroline M Komlo
- Section of Cardiothoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - T Sloane Guy
- Northeast Georgia Physicians Group Cardiovascular Surgery and Thoracic Surgery, 200 South Enota Drive Northeast, Suite 380, Gainesville, GA, 30501, USA.
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Abstract
Tricuspid valve disease carries a very unfavorable prognosis when medically treated. Despite that, surgical intervention is still underperformed for tricuspid valve disease due to the reported high morbidity and mortality from a sternotomy approach. This had led to a shift towards maximizing medical therapy for right ventricular failure and, as a result, a more significant delay in surgical referrals with surgical risks when patients are finally referred. Tricuspid valve patients usually have other co-morbidities resulting from their systemic venous congestion and low flow cardiac output. Minimally invasive tricuspid valve surgery provides less tissue injury and, as a result, less trauma during surgery. This provides a hope for both patients and treating doctors to be more open for providing this procedure with less complications. Isolated minimally invasive tricuspid valve surgery is still not performed as widely as expected. This can be partly due to the adverse outcomes historically labelled to tricuspid valve surgery or by the long journey of learning the surgical team would need to commit to with a minimal access approach. In this article we will review the perioperative pathway, and outcomes of isolated minimally invasive tricuspid valve surgery in the available English literature.
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Affiliation(s)
- Abdelrahman Abdelbar
- Department of Cardiothoracic surgery, Lancashire Heart Centre, Blackpool Teaching Hospital, Blackpool, UK
| | - Ayman Kenawy
- 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
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Abstract
Due to its potential benefits and increased patient satisfaction minimal invasive cardiac surgery (MICS) is rapidly gaining in popularity. These procedures are not without challenges and require careful planning, pre-operative patient assessment and excellent intraoperative communication. Assessment of patient suitability for MICS by a multi-disciplinary team during pre-operative workup is desirable. MICS requires additional skills that many might not consider to be part of the standard cardiac anesthetic toolkit. Anesthetists involved in MICS need not only be highly skilled in performing transesophageal echocardiography (TEE) but need to be proficient in multimodal analgesia, including locoregional or neuroaxial techniques. MICS procedures tend to cause more postoperative pain than standard median sternotomies do, and patients need analgesic management more in keeping with thoracic operations. Ultrasound guided peripheral regional anesthesia techniques like serratus anterior block can offer an advantage over neuroaxial techniques in patients on anti-platelet therapy or anticoagulation with low molecular weight or unfractionated heparin The article reviews the salient points pertaining to pre-operative assessment and suitability, intraoperative process and postoperative management of minimally invasive cardiac procedures in the operating theatre as well as the catheterization lab. Special emphasis is given to anesthetic management and analgesia techniques.
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Affiliation(s)
- Alexander White
- Senior Fellow in Anaesthetics and Intensive Care, The Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Chinmay Patvardhan
- Consultant in Anaesthetics and Intensive Care, The Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Florian Falter
- Consultant in Anaesthetics and Intensive Care, The Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
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Rajput NK, Kalangi TKV, Andappan A, Swain AK. MICS CABG: a single-center experience of the first 100 cases. Indian J Thorac Cardiovasc Surg 2021; 37:16-26. [PMID: 33442204 PMCID: PMC7778645 DOI: 10.1007/s12055-020-01048-2] [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] [Received: 05/18/2020] [Revised: 08/27/2020] [Accepted: 09/01/2020] [Indexed: 12/30/2022] Open
Abstract
PURPOSE To study the learning curve and outcomes of the first 100 cases of minimally invasive cardiac surgery (MICS) coronary artery bypass grafting (CABG) performed at our center. METHODS From January 2017 to November 2019, a total of 100 patients underwent CABG via left anterior thoracotomy approach. We have studied the operative times within the MICS CABG patients to analyze our learning curve. We also studied the postoperative outcomes and compared these with those of patients who underwent sternotomy during the same period. RESULTS The mean age was 59.33 ± 9.95 (range 37-82) years. The numbers of males and females were 72 and 28 respectively. The preoperative average ejection fraction (EF) was 51.08 ± 9.75%. All these patients underwent CABG via left thoracotomy approach, after satisfying the exclusion criteria. All patients received left internal mammary artery (LIMA) to left anterior descending (LAD) as a standard graft, with the radial artery and saphenous vein being the next alternative conduits. The average length of the incision was 6.06 ± 0.45 cm. Only 2 cases were done on pump. The average number of grafts per patient was 2.33 ± 0.92. The mean operative time was 132.40 ± 11.56 min. The mean duration of ventilation was 4.79 ± 1.90 h and average intensive care unit (ICU) stay was 2.62 ± 0.84 days. There was one conversion and no mortalities in our study. We had analyzed our operative times and noticed a significant reduction after the first 20 cases, which was our learning curve. CONCLUSION MICS CABG can be performed for multivessel disease with the same comfort as for a single or a double vessel disease, once the learning curve has been achieved. Only significant difference from the sternotomy approach was noted in the longer operative times for MICS CABG during the learning curve, and not thereafter. Significant benefits of MICS over sternotomy were noticed in the immediate postoperative parameters like duration of ventilation, mean drainage, postoperative pain, ICU stay, and hospital stay, with no difference in postoperative adverse events.
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Affiliation(s)
- Nitin Kumar Rajput
- Department of Cardiothoracic Surgery, NHMMI Narayana Superspeciality Hospital, Raipur, Chhattishgarh 492001 India
| | - Tej Kumar Varma Kalangi
- Department of Cardiothoracic Surgery, NHMMI Narayana Superspeciality Hospital, Raipur, Chhattishgarh 492001 India
| | - Arun Andappan
- Department of Anaesthesiology and Critical Care, NHMMI Narayana Superspeciality Hospital, Raipur, Chhattishgarh 492001 India
| | - Alok Kumar Swain
- Department of Anaesthesiology and Critical Care, NHMMI Narayana Superspeciality Hospital, Raipur, Chhattishgarh 492001 India
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Karuppiah N, Pehora C, Haller C, Taylor K. Surgical Closure of Atrial Septal Defects in Young Children-A Review of Anesthesia Care in Sternotomy and Thoracotomy Approaches. J Cardiothorac Vasc Anesth 2020; 35:123-127. [PMID: 32758407 DOI: 10.1053/j.jvca.2020.07.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/03/2020] [Accepted: 07/04/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To review and compare the anesthetic management of atrial septal defect (ASD) closures via mini lateral thoracotomy and sternotomy approaches. DESIGN Retrospective analysis. SETTING Single- center pediatric quaternary care hospital. PARTICIPANTS Patients aged <8 years of age undergoing ASD closure. INTERVENTION None. MEASUREMENTS AND MAIN RESULTS Outcome measures included anesthetic technique, total amount and type of analgesics, pain scores, procedure duration, complications, blood transfusion requirements, and duration of stay. Each group had 15 patients. All patients in the sternotomy group received 0.25% bupivacaine subcutaneous infiltration. Eleven of the 15 thoracotomy patients received a fascial plane block, including serratus anterior and erector spinae blocks, and 3 received subcutaneous infiltration. There was no difference in opioid consumption intraoperatively or in the first 24 hours after surgery (0.28 ± 0.24 mg/kg morphine equivalents in thoracotomy group and 0.21 ± 0.12 mg/kg in sternotomy group). Duration of procedure and cardiopulmonary bypass duration were longer in the thoracotomy group. There was no difference in cross-clamp duration between groups. There was no difference in intensive care unit or hospital stay. CONCLUSIONS The authors reviewed perioperative pain management strategies used in surgical ASD closures. Different fascial plane blocks were used. This study has paved way to design a randomized control trial to compare various regional techniques for cardiac surgeries and identified opportunities for improved pain assessment scoring in children after cardiac surgery.
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Affiliation(s)
- Niveditha Karuppiah
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Carolyne Pehora
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Christoph Haller
- Division of Cardiovascular Surgery, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Canada
| | - Katherine Taylor
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Canada; University of Toronto, Toronto, Canada.
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Zhang C, Yue J, Li M, Jiang W, Pan Y, Song Z, Shi C, Fan W, Pan Z. Bronchial blocker versus double-lumen endobronchial tube in minimally invasive cardiac surgery. BMC Pulm Med 2019; 19:207. [PMID: 31706317 PMCID: PMC6842514 DOI: 10.1186/s12890-019-0956-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 10/10/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To compare the therapeutic value of a bronchial blocker (BB) with a double-lumen tube (DLT) in minimally invasive cardiac surgery (MICS). METHODS Sixty patients who underwent MICS were randomized to use either a DLT (Group D, n = 30) or a BB (Group B, n = 29; one failed was omitted). The following data were collected: time of intubation and tube localization; incidence of tube displacement; postoperative sore throat and hoarseness; time of cardiopulmonary bypass; maintenance time for SpO2 < 90% (PaCO2 < 60 mmHg); mean arterial pressure and heart rate; SpO2, PaO2, PaCO2, EtCO2, mean airway pressure, and airway peak pressure; surgeons' satisfaction with anesthesia; and short-term complications. RESULTS The times of intubation and tube localization were significantly longer in Group B than in Group D (P < 0.05). Patients in Group B exhibited significantly lower incidence of tube displacement, postoperative sore throat, and hoarseness when compared with patients in Group D (P < 0.05). Mean arterial pressure and heart rate were significantly lower in Group B than in Group D after tracheal intubation (P < 0.05). The mean airway pressure and airway peak pressure were significantly lower in Group B than in Group D after one-lung ventilation (P < 0.05). SpO2 and PaO2 in Group B were significantly higher than in group D after cardiopulmonary bypass (P < 0.05). No short-term postoperative complications were observed in patients of Groups B and D during 3 month follow-up. CONCLUSION BB can be a potential alternative to the conventional DLT for lung isolation in MICS. TRIAL REGISTRATION ChiCTR1900024250, July 2, 2019.
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Affiliation(s)
- Chuncheng Zhang
- Department of Anesthesiology, The Second Hospital of Jilin University, No.218 Ziqiang Street, Nanguan District, Changchun, 130041, Jilin province, China
| | - Jing Yue
- Department of Anesthesiology, The Second Hospital of Jilin University, No.218 Ziqiang Street, Nanguan District, Changchun, 130041, Jilin province, China
| | - Mingyue Li
- Department of Anesthesiology, The Second Hospital of Jilin University, No.218 Ziqiang Street, Nanguan District, Changchun, 130041, Jilin province, China
| | - Wei Jiang
- Department of Anesthesiology, The Second Hospital of Jilin University, No.218 Ziqiang Street, Nanguan District, Changchun, 130041, Jilin province, China
| | - Yu Pan
- Yanbian University, Yanbian, 130000, Jilin province, China
| | - Zhimin Song
- Department of Anesthesiology, The Second Hospital of Jilin University, No.218 Ziqiang Street, Nanguan District, Changchun, 130041, Jilin province, China
| | - Cailian Shi
- Department of Anesthesiology, The Second Hospital of Jilin University, No.218 Ziqiang Street, Nanguan District, Changchun, 130041, Jilin province, China
| | - Weixuan Fan
- Department of Intensive Care Unit, The Second Hospital of Jilin University, Changchun, 130041, Jilin province, China
| | - Zhenxiang Pan
- Department of Anesthesiology, The Second Hospital of Jilin University, No.218 Ziqiang Street, Nanguan District, Changchun, 130041, Jilin province, China.
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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]
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Parnell A, Prince M. Anaesthesia for minimally invasive cardiac surgery. BJA Educ 2018; 18:323-330. [PMID: 33456797 DOI: 10.1016/j.bjae.2018.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2018] [Indexed: 12/18/2022] Open
Affiliation(s)
- A Parnell
- Northern General Hospital, Sheffield, UK
| | - M Prince
- Sheffield Teaching Hospitals, Sheffield, UK
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Vohra HA, Ahmed EM, Meyer A, Kempfert J. Knowledge transfer and quality control in minimally invasive aortic valve replacement. Eur J Cardiothorac Surg 2018; 53:ii9-ii13. [DOI: 10.1093/ejcts/ezy077] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 02/01/2018] [Indexed: 01/05/2023] Open
Affiliation(s)
- Hunaid A Vohra
- Bristol Heart Institute, University Hospitals, Bristol, UK
| | | | - Alexander Meyer
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research) partner site Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Joerg Kempfert
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum, Berlin, Germany
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Liu Z, He W, Jia Q, Yang X, Liang S, Wang X. A comparison of extraluminal and intraluminal use of the Uniblocker in left thoracic surgery: A CONSORT-compliant article. Medicine (Baltimore) 2017; 96:e6966. [PMID: 28538393 PMCID: PMC5457873 DOI: 10.1097/md.0000000000006966] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The aim of this study was to assess the feasibility and safety issues concerning extraluminal use of the Uniblocker for one-lung ventilation (OLV) in the left thoracic surgery. METHODS Forty patients undergoing elective left thoracic surgery were included in this study, and all patients were randomly allocated to extraluminal use of Uniblocker group (E group, n = 20) or intraluminal use of Uniblocker group (I group, n = 20). Time for intubation, time for verification of the correct position of Uniblocker, incidence of Uniblocker displacement, index of pulmonary collapse, mean arterial pressure, heart rate, peak airway pressure, oxygen saturation in two-lung ventilation, and 30 minutes after OLV, bronchial damage after OLV, sore throat, and hoarseness postoperative were recorded. RESULTS The time for positioning Uniblocker was 112.6 ± 31.2 seconds in intraluminal use group, whereas the time for positioning Uniblocker was significantly shorter in extraluminal use group (63.4 ± 15.8 seconds). The incidence of main bronchial injury, the time of intubation, the incidence of Uniblocker malposition after initial placement, the time of OLV, the degree of pulmonary collapse, mean arterial pressure, heart rate, peak airway pressure, oxygen saturation in two-lung ventilation, and 30 minutes after OLV, the incidence of sore throat and hoarseness postoperative have no statistical significance (P > .05). CONCLUSION Extraluminal use of the Uniblocker was proved to be a more rapid and more accurate method than conventional intraluminal use of the Uniblocker for OLV in left thoracic surgery.
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Affiliation(s)
- Zhuo Liu
- Department of Anesthesiology, The Third Hospital of Hebei Medical University, Shijiazhuang
| | - WenSheng He
- Department of Anesthesiology, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei, China
| | - QianQian Jia
- Department of Anesthesiology, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei, China
| | - XiaoChun Yang
- Department of Anesthesiology, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei, China
| | - ShuJuan Liang
- Department of Anesthesiology, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei, China
| | - XiuLi Wang
- Department of Anesthesiology, The Third Hospital of Hebei Medical University, Shijiazhuang
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