Minimally Invasive Aortic Root Replacement with Valved Conduits through Partial Upper Sternotomy

2017 ◽  
Vol 66 (04) ◽  
pp. 295-300 ◽  
Author(s):  
Mosab Alshakaki ◽  
Sven Martens ◽  
Mirela Scherer ◽  
Julia Hillebrand
Keyword(s):  
Minimally Invasive ◽  
Aortic Root ◽  
Operative Procedure ◽  
Median Sternotomy ◽  
Clinical Results ◽  
Aortic Root Replacement ◽  
Conventional Approach ◽  
Surgical Access ◽  
Secondary Bleeding ◽  
Minimally Invasive Access

Background Minimally invasive surgical access through limited sternotomy reduces trauma and morbidity in cardiosurgical patients. However, until now, it is not the standard access for aortic root replacement. This study details our clinic's experience with minimally invasive implantation of valved conduits through partial upper sternotomy and the comparison to conventional full median sternotomy. Methods Between January 2012 and March 2016, a total of 187 patients underwent aortic root replacement with valved conduits in our department. Minimally invasive access through partial upper sternotomy (group A) was performed in 33 patients (9 female, 24 male; mean age: 55.68 ± 13.24 years). Four of these patients received concomitant mitral and tricuspid valve interventions. The results were compared with similar procedures through conventional approach (group B): 25 patients (7 female, 18 male; mean age: 59.09 ± 12.32 years). Results In all 33 cases of minimally invasive access and 25 cases of conventional approach, aortic root replacement was successful. Operative times were as follows (in minutes; groups A and B)—cardiopulmonary bypass: 166.12 ± 40.61 and 162.88 ± 45.89; cross-clamp time: 122.24 ± 27.42 and 113.44 ± 22.57, respectively. In both groups, two patients needed postoperative reexploration due to secondary bleeding. One multimorbid patient suffered from postoperative stroke and died on the ninth postoperative day due to heart failure. The observed operation times and clinical results after minimally invasive surgery are comparable to conduit implantation through full median sternotomy. Conclusions Partial upper sternotomy is a feasible access for safe aortic root replacement with valved conduits. Nevertheless, minimally invasive aortic root replacement is a challenging operative procedure.

Minimally Invasive Versus Conventional Aortic Root Replacement − A Systematic Review and Meta-Analysis

2019 ◽  
Vol 28 (12) ◽  
pp. 1841-1851 ◽  
Author(s):  
Amer Harky ◽  
Ahmed Al-Adhami ◽  
Jeffrey S.K. Chan ◽  
Chris H.M. Wong ◽  
Mohamad Bashir
Keyword(s):  
Systematic Review ◽  
Minimally Invasive ◽  
Aortic Root ◽  
Meta Analysis ◽  
Aortic Root Replacement

Current Trends in Aortic Root Surgery

2018 ◽  
Vol 13 (2) ◽  
pp. 91-96 ◽  
Author(s):  
Djamila Abjigitova ◽  
Georgia Panagopoulos ◽  
Oleg Orlov ◽  
Vishal Shah ◽  
Konstadinos A. Plestis
Keyword(s):  
Aortic Root ◽  
Circulatory Arrest ◽  
Ventilatory Support ◽  
Median Sternotomy ◽  
Aortic Root Replacement ◽  
Interquartile Range ◽  
Red Blood Cell Transfusion ◽  
Prolonged Length ◽  
Bentall Procedure ◽  
Significant Difference

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.

scholarly journals Toward Routine Minimally Invasive Ventricular Septal Defect Closure Via Right Lateral Minithoracotomy

2021 ◽  
Vol 9 ◽  
Author(s):  
Selim Aydin ◽  
Bahar Temur ◽  
Serdar Basgoze ◽  
Fusun Guzelmeric ◽  
Osman Guvenc ◽  
...  
Keyword(s):  
Ventricular Septal Defect ◽  
Minimally Invasive ◽  
Septal Defect ◽  
Pulmonary Stenosis ◽  
Median Sternotomy ◽  
Major Complication ◽  
Clinical Results ◽  
Aortic Cross Clamp Time ◽  
Ventricular Septal Defect Closure

Background: Improving the surgical results and recent advancement of transcatheter techniques for closure of ventricular septal defect (VSD) increased the demand for minimally invasive approaches. In this study, we analyzed the results of the patients who underwent VSD closure with right lateral minithoracotomy (RLMT).Methods: Between September 2014 and February 2021, 24 patients underwent minimally invasive VSD closure with RLMT. The median age of the patients was 16 months (range, 4-84 months). Fifteen patients (62.5%) were female. The median weight of the patients was 9.75 kg (range, 4.6-30 kg). The types of VSD were perimembranous in 19 patients, subaortic in three patients, inlet in one patient, and subpulmonic in one patient. Five patients had low-lying pulmonary stenosis in addition to VSD.Results: No perioperative death or major complication occurred during follow-up. All defects were repaired through RLMT. The median cardiopulmonary bypass time was 81 min (range, 44-163 min), and the aortic cross-clamp time was 65 min (range, 33-131 min). The median hospital stay was 6 days (range, 5-21 days). One patient had minimal (2 mm) residual left-to-right shunt. All families were satisfied with the cosmetic results during the follow-up.Conclusions: The RLMT method is a safe and effective alternative to standard median sternotomy for VSD closure and can be performed with favorable cosmetic and clinical results.

scholarly journals Aortic Root Replacement via A Minimally Invasive Approach is Safe

2017 ◽  
Vol 65 (S 01) ◽  
pp. S1-S110
Author(s):  
C. Bening ◽  
K. Hamouda ◽  
C. Schimmer ◽  
I. Aleksic ◽  
D. Radakovic ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Aortic Root ◽  
Aortic Root Replacement ◽  
Minimally Invasive Approach ◽  
Invasive Approach

scholarly journals Recent advances in aortic valve replacement

F1000Research ◽  
2019 ◽  
Vol 8 ◽  
pp. 1159 ◽  
Author(s):  
Cristiano Spadaccio ◽  
Khalid Alkhamees ◽  
Nawwar Al-Attar
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Minimally Invasive ◽  
Valve Replacement ◽  
Median Sternotomy ◽  
Surgical Aortic Valve Replacement ◽  
Complete Excision ◽  
Surgical Access ◽  
Transcatheter Valve ◽  
Transcatheter Valves

Aortic valve replacement has stood the test of time but is no longer an operation that is exclusively approached through a median sternotomy using only sutured prostheses. Currently, surgical aortic valve replacement can be performed through a number of minimally invasive approaches employing conventional mechanical or bioprostheses as well as sutureless valves. In either case, the direct surgical access allows inspection of the valve, complete excision of the diseased leaflets, and debridement of the annulus in a controlled and thorough manner under visual control. It can be employed to treat aortic valve pathologies of all natures and aetiologies. When compared with transcatheter valves in patients with a high or intermediate preoperative predictive risk, conventional surgery has not been shown to be inferior to transcatheter valve implants. As our understanding of sutureless valves and their applicability to minimally invasive surgery advances, the invasiveness and trauma of surgery can be reduced and outcomes can improve. This warrants further comparative trials comparing sutureless and transcatheter valves.

scholarly journals POTENTIALS OF MINI-INVASIVE ENDORHINOSURGERY TAKING INTO ACCOUNT THE ACTUAL BOUNDARIES OF THE FIELD OF VIEW OF MODERN ENDOSCOPES

2020 ◽  
Vol 20 (4) ◽  
pp. 232-236
Author(s):  
Ya.V. Shkorbotun
Keyword(s):  
Minimally Invasive ◽  
Maxillary Sinus ◽  
Optical Axis ◽  
Field Of View ◽  
Optical Characteristics ◽  
Viewing Angle ◽  
Axis Orientation ◽  
Surgical Access ◽  
Minimally Invasive Access ◽  
The Individual

One of the predetermining factors to perform minimally invasive rhinosurgery successfully is the searching for optimal surgical access areas, the choice of which at present mostly depends on the visualization capabilities of endoscopic devices. The angular vision is one of the important factors for planning and performing endonasal interventions on the anterior maxillary sinus. A large viewing angle allows surgeons to expand the potentials of minimally invasive access, reduce the need to replace endoscopes with different angles during the intervention and improve the quality of the surgical procedure. The purpose of this study was to improve the method for selecting surgical access to the maxillary sinus, taking into the optical axis and the actual size of the field of view provided by the endoscope. The simulation of the process of selecting the optimal option for access to the maxillary sinus on the basis of our own method of predicting the visualization of the lumen in the sinus was performed. To determine the actual viewing angle of the endoscope, we compared the application of the standard methodology and the approach we elaborated. 3 endoscopes with a 70° optical axis orientation were examined; the studies were performed three times. We found that the results of determining the boundaries of the field of view according to our technique and to the method of Wang Q. et al. (2017) did not differ significantly, that indicates the comparable accuracy of both methods. With the declared identical characteristics of all three endoscopes, we revealed the magnitude of the field of view differed quite significantly (by a maximum of 8.7°). Moreover, the value of the viewing angle in all samples of endoscopes tested was greater than that provided by the manufacturer for standard endoscopes (60 °). The average duration of measuring the magnitude of the field of view of the endoscope by the method we proposed took 25.3 ± 3.2 s that was significantly faster than by the method of Wang Q. et al. (2017), 83.7 ± 2.0 s P≤0.05). We should also stress on the greater convenience of carrying out examinations according to our method. When assessing the potential of the maxillary sinus visualization, it is necessary to take into account not only the individual anatomical features of a patient, but also the actual optical characteristics of endoscopes. The device we designed for determining the boundaries of the field of view of endoscopes is easy to manufacture, requires less time for testing and enables to determine the actual viewing angles of the endoscope quicker and more effectively. Actual optical characteristics of endoscopes may differ from the standards.

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