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Instrumentation and Operating Theater Set up in Minimally Invasive Cardiac Surgery
Published in Theo Kofidis, Minimally Invasive Cardiac Surgery, 2021
Minimally invasive cardiac surgery is a complex operative procedure with its most common concerns over surgical exposure and the potential need for prolonged operative time. All of it translates to overall patient safety. Assiduous instrumentation, appropriate operation theater set up, innovations in perfusion techniques, the use of cerebral oximetry and the development of specialized surgical instruments and robotic technology have changed the outcome of the minimally invasive cardiac surgery.
Evaluation of Three Different Techniques for the Closure of Ventricular Septal Defects
Published in Journal of Investigative Surgery, 2021
Dimos Karangelis, Spiros Loggos, Aphrodite Tzifa, Fotios Mitropoulos
The transthoracic device closure is a hybrid approach for the closure of VSDs which was introduced by Amin and coworkers in the late 1990s [17]. This approach which combines the advantages of minimally invasive cardiac surgery and interventional cardiology, requires a partial lower sternotomy and is guided by transesophageal echocardiography. This method has been reported to be safe with rates of VSD closure ranging from 93.4% to 96.3% [18–21]. However, this procedure may cause aortic regurgitation, cAVB, significant residual shunts or device migration. In the study of Chen and colleagues [21], which comprised 1090 cases, cAVB occurred in 1.6% of the patients and 4 patients received permanent pacemaker. Fifty-seven cases were converted to conventional surgical repair under CPB. Of the 57 cases, 13 patients presented new severe aortic valve regurgitation (AI), in 8 patients there was failure to establish a correct transfer orbit while 3 cases suffered device migration and 3 patients significant residual shunt [21]. Well recognized limitations of this method include preoperative AI, coexisting cardiac anomalies, very large (>12 mm) or very small defects (<2 mm) [21].
Current practice in atrial septal defect occlusion in children and adults
Published in Expert Review of Cardiovascular Therapy, 2020
Wail Alkashkari, Saad Albugami, Ziyad M. Hijazi
In considering the potential risk of device erosion, an important question is whether surgical closure can be made safer and less morbid for patients. Minimally invasive cardiac surgery (MICS), through ‘mini-sternotomy’ or video-assisted thoracoscopic surgery (with or without robotic assistance), has the potential to reduce procedural morbidity relative to open heart surgery with reductions in length of stay along with improved cosmesis compared with conventional surgical correction of ASD [85]. However, the largest series demonstrates that MICS patients were exposed to increased cardiopulmonary bypass times but spent less time on the ventilator. In each of the three series, the median lengths of stay remained between 5 and 7 days, which remains significantly longer than transcatheter closure (usually less than a day). Cost comparison of MICS to traditional surgical closure, or transcatheter closure for that matter, was not attempted. Given longer length of stay, one would expect that MICS will be more expensive than either approaches [86–88]. At this time, enthusiasm for MICS is limited to few centers, and its future as an alternative therapy remains uncertain.
Mitral Valve Surgery in Pulmonary Hypertension Patients: Is Minimally Invasive Surgery Safe?
Published in Structural Heart, 2020
Mark Helmers, Samuel Kim, Peter Altshuler, Amit Iyengar, Jason Han, John Kelly, W. Clark Hargrove, Pavan Atluri
Methods: Retrospective analysis of our institution’s MV database was performed between November 1998 and March 2019 for all adult patients undergoing MV surgery. Patients undergoing additional valve, coronary, or aortic procedures were excluded, as were patients who did not have preoperative hemodynamic data. PH was defined as mean pulmonary artery pressure greater than or equal to 25 mmHg. Patients were stratified by FS or minimally invasive cardiac surgery (MICS). Baseline characteristics and perioperative outcomes were compared between surgical approaches among patients who met the study criteria.