scholarly journals Comparison of the safety and efficacy between minimally invasive cardiac surgery and median sternotomy in a low-risk mixed Asian population in Singapore

2021 ◽  
Author(s):  
ZX Ong ◽  
DD Wu ◽  
HD Luo ◽  
GH Chang ◽  
F Sazzad ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Minimally Invasive ◽  
Artery Bypass ◽  
Median Sternotomy ◽  
Asian Population ◽  
Minimally Invasive Cardiac Surgery ◽  
Invasive Approach ◽  
Cardiac Procedures ◽  
Defect Repair ◽  
Postoperative Length

Introduction: Minimally invasive cardiac surgery (MICS) has attracted increasing attention, with institutions increasingly adopting this approach over conventional median sternotomy (MS). This study aimed to describe the outcomes of minimally invasive cardiac surgery in our institution as the only centre with an established MICS programme in Singapore. Methods: Patients who had undergone cardiac procedures such as heart valve replacement or repair, coronary artery bypass grafting or atrial septal defect repair were included in the study. We analysed 4063 patients who had undergone MS and 390 patients who had undergone MICS between January 2009 and February 2020. Results: Over the years, the number of MICS procedures performed increased, along with an increase in MICS operations with two or more concomitant cardiac procedures and a decrease in postoperative length of stay. Compared with patients who underwent MS, those who underwent MICS had shorter length of postoperative hospital stay (p < 0.001). On multivariate analysis, patients who underwent MICS had lower rates of atrial fibrillation (p = 0.021), reoperation (p = 0.028) and prolonged ventilation (p < 0.001). However, the rates of other postoperative complications were comparable between patients who underwent MICS and those who underwent MS. Conclusion: In our institution, MICS is a safe, reproducible and efficacious technique that yields superior outcomes compared with conventional MS procedures, in some aspects. The results of this study provide further evidence and support towards adopting the minimally invasive approach to cardiac surgery in a carefully selected group of cardiac patients in Singapore.

scholarly journals Perfusion Strategy for Minimally Invasive Cardiac Surgery

2021 ◽  
pp. 90-98
Author(s):  
Oleksandr D. Babliak ◽  
Volodymyr M. Demianenko ◽  
Anton I. Marchenko ◽  
Lilia V. Pidgaina ◽  
Dmytro Ye. Babliak ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Minimally Invasive ◽  
Ct Scan ◽  
Aortic Surgery ◽  
Median Sternotomy ◽  
The Body ◽  
Minimally Invasive Cardiac Surgery ◽  
Invasive Approach ◽  
Cannulation Site ◽  
Preoperative Ct

Minimally invasive cardiac surgery (MICS) has a number of proven advantages compared to median sternotomy. Safe cannulation and perfusion are some of the main components of the success of MICS. The aim. To present our perfusion strategy and describe the methods of cannulation, technical features, contraindications and potential complications. Materials and methods. We examined the results of 1088 adult patients who underwent primary cardiac surgery in our hospital (coronary artery bypass grafting, valve surgery, aortic surgery, left ventricle repair, congenital cardiac surgery and combined procedures) from July 2017 to May 2021. Of these, 851 patients were qualified for MICS. To select a safe cannulation strategy, we performed contrast enhanced computed tomography (CT) of the aorta and main branches for all the patients, also we calculated the body surface area according to the DuBois and DuBois formula. Results. We performed 838 minimally invasive on-pump procedures, which is 98.5% of all patients qualified for MICS. According to the results of the preoperative CT scan, 13 (1.5%) patients were not operated with the minimally invasive approach due to the hazards related to the provision of cardiopulmonary bypass. Peripheral cannulation was performed in 754 (90%) patients and an alternative cannulation site was selected in 62 (8.2%) patients based on preoperative CT data. There were 10 (1.32%) patients who developed major complications (stroke, acute aortic dissection, acute renal failure requiring hemodialysis) after peripheral cannulation. Conclusions. Preoperative CT scan is mandatory for planning a perfusion strategy in minimally invasive cardiac surgery. The required surgical techniques should include cannulation of the right and left femoral and right axillary arteries.

Cardiac Surgery: Beyond Conventional Sternotomy With Cardiopulmonary Bypass

2020 ◽  
Vol 40 (1) ◽  
pp. 66-73
Author(s):  
Sharon Wahl
Keyword(s):  
Cardiac Surgery ◽  
Minimally Invasive ◽  
Artery Bypass ◽  
High Risk Patient ◽  
Risk Groups ◽  
Tricuspid Valve Repair ◽  
Off Pump ◽  
Risks And Benefits ◽  
Cardiac Procedures ◽  
Pump Coronary Artery Bypass

Minimally invasive cardiac surgery options, which originated with off-pump coronary artery bypass grafting and aortic valve procedures, continue to evolve in order to address complex conditions, including those requiring mitral and tricuspid valve repair. Although these procedures are primarily indicated for high-risk patient populations, favorable patient outcomes have resulted in recommendations being expanded to include intermediate-risk groups. This article increases nursing-related knowledge of minimally invasive cardiac procedures, providing an overview of current minimally invasive cardiac surgeries and their associated risks and benefits.

Experience with a Minimally Invasive Approach to Combined Valve Surgery and Coronary Artery Bypass Grafting through Bilateral Thoracotomies

2013 ◽  
Vol 16 (3) ◽  
pp. 125 ◽  
Author(s):  
Pieter J. S. Smit ◽  
Masood A. Shariff ◽  
John P. Nabagiez ◽  
Muhammad A. Khan ◽  
Scott M. Sadel ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Minimally Invasive ◽  
Artery Bypass ◽  
Median Sternotomy ◽  
Valve Surgery ◽  
Invasive Approach ◽  
Invasive Group ◽  
The Mean ◽  
Artery Disease ◽  
Mean Time

<p><b>Background:</b> Minimally invasive coronary artery bypass grafting (MICS-CABG) and minimally invasive valve surgery (MIVS) have been used independently to manage occlusive coronary artery disease and valvular diseases, respectively. We present 12 patients who underwent combined MICS-CABG and MIVS via bilateral mini-thoracotomies.</p><p><b>Methods:</b> We retrospectively reviewed 116 consecutive valve/CABG operations by a single surgeon and compared the outcomes obtained via sternotomy with those obtained via bilateral minithoracotomies.</p><p><b>Results:</b> Six patients in the MIVS group underwent aortic valve replacement (sternotomy group, n = 70), 3 patients underwent mitral valve repair (sternotomy group, n = 9), and 3 underwent mitral valve replacement (sternotomy group, n = 25). The minimally invasive valve surgeries were combined with MICS-CABG for single- (n = 2), double- (n = 9), and triple-vessel (n = 1) coronary artery disease in a single operation. The mean SD duration of cardiopulmonary bypass was 164 ± 44.6 minutes (mean time via sternotomy, 152 ± 50.5 minutes; <i>P</i> = .4146), and the mean aortic cross-clamp time was 87.8 ± 22.1 minutes (mean time via sternotomy, 105 ± 39.8 minutes; <i>P</i> = .1455). The use of perioperative blood transfusions averaged to 2.3 ± 5.6 units (mean usage via sternotomy, 2.7 ± 4.9 units; <i>P</i> = .8326). There were no conversions to sternotomy in the minimally invasive group. Patients in the minimally invasive group were extubated earlier (24 ± 11 hours; sternotomy group, 40 ± 61 hours; <i>P</i> = .3684) and discharged earlier (7 ± 4 days) than patients who underwent median sternotomy (9 ± 10 days; <i>P</i> = .4027).</p><p><b>Conclusion:</b> MICS-CABG combined with MIVS via bilateral minithoracotomies yielded short-term results comparable to those for CABG and valve repair via median sternotomy. There were no operative mortalities or reoperations. The possible advantages of the minimally invasive approach included earlier extubation and earlier discharge from the hospital. Combined CABG and valve surgery can be safely performed via bilateral thoracotomies.</p>

scholarly journals Demographic and Surgical Profile of the Patients Underwent Minimally Invasive Cardiac Surgery in a Rural Center of Bangladesh

KYAMC Journal ◽  
2021 ◽  
Vol 12 (2) ◽  
pp. 71-74
Author(s):  
Mahbub Ahsan ◽  
Lutfar Rahman ◽  
ASM Shariful Islam ◽  
Prokash Chandra Munshi ◽  
Md Muzibur Rahman ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Minimally Invasive ◽  
Superior Vena ◽  
Femoral Vein ◽  
Artery Bypass ◽  
Minimally Invasive Cardiac Surgery ◽  
Common People ◽  
Medical College ◽  
Anterolateral Thoracotomy ◽  
Operative Outcome

Background: Ever Since its inception , minimally invasive cardiac surgery is growing rapidly for better convenience and superb post operative outcome. As newer instruments, surgical technique and operative exposure are increasing more and more patients are demanding minimally invasive cardiac surgery. Objective: The study was conducted to evaluate the various pre operative and peroperative factors in minimally invasive cardiac surgery. Materials and Methods: A retrospective observational study on the patients who underwent minimally invasive cardiac surgery in the department of cardiovascular and thoracic surgery, Khwaja Yunus Ali Medical College, Sirajganj, Bangladesh from January 2016 to December 2020. Results: A total of 40 cases were operated through minimally invasive cardiac surgery in our department. Maximum number of cases was Atrial septal defect(ASD), and minimally invasive direct coronary artery bypass (MIDCAB). About 62.50% were female, majority of patients were in the range of 11-15 years. Right anterolateral thoracotomy was done in 27 cases and left anterolateral thoracotomy in 10 cases. The maximum number of cannulation done in femoral artery and femoral vein, followed by direct superior vena caval cannulation and only a single percutaneous superior venacaval cannulation through internal jugular vein. In 14 cases the length of incision was in the range of 3-4 cm and 12 cases in 4-5cm. Conclusion: Minimally invasive cardiac surgery is now becoming more demanding. As more and more centers are opening the door to newer technology, common people are also becoming conscious about its excellent post operative outcome. KYAMC Journal.2021;12(02): 71-74

Surgical closure of atrial septal defect Minimally invasive cardiac surgery or median sternotomy?

1998 ◽  
Vol 12 (6) ◽  
pp. 820-824 ◽  
Author(s):  
C. H. Chang ◽  
P. J. Lin ◽  
J. J. Chu ◽  
H. P. Liu ◽  
F. C. Tsai ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Minimally Invasive ◽  
Atrial Septal Defect ◽  
Septal Defect ◽  
Median Sternotomy ◽  
Minimally Invasive Cardiac Surgery ◽  
Surgical Closure

Intrathecal Morphine for Analgesia in Minimally Invasive Cardiac Surgery: A Randomized, Placebo-controlled, Double-blinded Clinical Trial

2021 ◽  
Author(s):  
Richa Dhawan ◽  
Danisa Daubenspeck ◽  
Kristen E. Wroblewski ◽  
John-Henry Harrison ◽  
Mackenzie McCrorey ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Cardiac Surgery ◽  
Minimally Invasive ◽  
Intrathecal Morphine ◽  
Artery Bypass ◽  
Minimally Invasive Cardiac Surgery ◽  
Analog Scale ◽  
Pain Scores ◽  
Double Blinded ◽  
Postoperative Morphine

Background Intrathecal morphine decreases postoperative pain in standard cardiac surgery. Its safety and effectiveness have not been adequately evaluated in minimally invasive cardiac surgery. The authors hypothesized that intrathecal morphine would decrease postoperative morphine consumption after minimally invasive cardiac surgery. Methods In this randomized, placebo-controlled, double-blinded clinical trial, patients undergoing robotic totally endoscopic coronary artery bypass received either intrathecal morphine (5 mcg/kg) or intrathecal saline before surgery. The primary outcome was postoperative morphine equivalent consumption in the first 24 h after surgery; secondary outcomes included pain scores, side effects, and patient satisfaction. Pain was assessed via visual analog scale at 1, 2, 6, 12, 24, and 48 h after intensive care unit arrival. Opioid-related side effects (nausea/vomiting, pruritus, urinary retention, respiratory depression) were assessed daily. Patient satisfaction was evaluated with the Revised American Pain Society Outcome Questionnaire. Results Seventy-nine patients were randomized to receive intrathecal morphine (n = 37) or intrathecal placebo (n = 42), with 70 analyzed (morphine 33, placebo 37). Intrathecal morphine patients required significantly less median (25th to 75th percentile) morphine equivalents compared to placebo during first postoperative 24 h (28 [16 to 46] mg vs. 59 [41 to 79] mg; difference, –28 [95% CI, –40 to –18]; P &lt; 0.001) and second postoperative 24 h (0 [0 to 2] mg vs. 5 [0 to 6] mg; difference, –3.3 [95% CI, –5 to 0]; P &lt; 0.001), exhibited significantly lower visual analog scale pain scores at rest and cough at all postoperative timepoints (overall treatment effect, –4.1 [95% CI, –4.9 to –3.3] and –4.7 [95% CI, –5.5 to –3.9], respectively; P &lt; 0.001), and percent time in severe pain (10 [0 to 40] vs. 40 [20 to 70]; P = 0.003) during the postoperative period. Mild nausea was more common in the intrathecal morphine group (36% vs. 8%; P = 0.004). Conclusions When given before induction of anesthesia for totally endoscopic coronary artery bypass, intrathecal morphine decreases use of postoperative opioids and produces significant postoperative analgesia for 48 h. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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