Perfusion Strategy for Minimally Invasive Cardiac Surgery

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.

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

Singapore Medical Journal ◽

10.11622/smedj.2021136 ◽

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.

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Minimally Invasive Cardiac Surgery versus Conventional Median Sternotomy for Atrial Septal Defect Closure

The Korean Journal of Thoracic and Cardiovascular Surgery ◽

10.5090/kjtcs.2016.49.6.421 ◽

2016 ◽

Vol 49 (6) ◽

pp. 421-426 ◽

Cited By ~ 8

Author(s):

Joon Chul Jung ◽

Kyung-Hwan Kim

Keyword(s):

Cardiac Surgery ◽

Minimally Invasive ◽

Atrial Septal Defect ◽

Septal Defect ◽

Median Sternotomy ◽

Minimally Invasive Cardiac Surgery ◽

Defect Closure ◽

Atrial Septal Defect Closure

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The Arrowhead Ministernotomy with Rigid Sternal Plate Fixation: A Minimally Invasive Approach for Surgery of the Ascending Aorta and Aortic Root

Minimally Invasive Surgery ◽

10.1155/2014/681371 ◽

2014 ◽

Vol 2014 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Mark J. Russo ◽

John Gnezda ◽

Aurelie Merlo ◽

Elizabeth M. Johnson ◽

Mohammad Hashmi ◽

...

Keyword(s):

Minimally Invasive ◽

Aortic Root ◽

Plate Fixation ◽

Aortic Surgery ◽

Case Series ◽

Ascending Aorta ◽

The Body ◽

Minimally Invasive Approach ◽

Invasive Approach ◽

Novel Approach

Background. Ministernotomy incisions have been increasingly used in a variety of settings. We describe a novel approach to ministernotomy using arrowhead incision and rigid sternal fixation with a standard sternal plating system.Methods. A small, midline, vertical incision is made from the midportion of the manubrium to a point just above the 4th intercostal mark. The sternum is opened in the shape of an inverted T using two oblique horizontal incisions from the midline to the sternal edges. At the time of chest closure, the three bony segments are aligned and approximated, and titanium plates (Sternalock, Jacksonville, Florida) are used to fix the body of the sternum back together.Results. This case series includes 11 patients who underwent arrowhead ministernotomy with rigid sternal plate fixation for aortic surgery. The procedures performed were axillary cannulation (n=2), aortic root replacement (n=3), valve sparing root replacement (n=3), and replacement of the ascending aorta (n=11) and/or hemiarch (n=2). Thirty-day mortality was 0%; there were no conversions, strokes, or sternal wound infections.Conclusions. Arrowhead ministernotomy with rigid sternal plate fixation is an adequate minimally invasive approach for surgery of the ascending aorta and aortic root.

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Minimally invasive approach: is this the future of aortic surgery?

Indian Journal of Thoracic and Cardiovascular Surgery ◽

10.1007/s12055-021-01258-2 ◽

2021 ◽

Author(s):

Paolo Berretta ◽

Michele Galeazzi ◽

Mariano Cefarelli ◽

Jacopo Alfonsi ◽

Veronica De Angelis ◽

...

Keyword(s):

Minimally Invasive ◽

Aortic Surgery ◽

Median Sternotomy ◽

Surgical Techniques ◽

Current Evidence ◽

Invasive Approach ◽

Less Invasive ◽

First Choice ◽

Aortic Interventions ◽

Invasive Techniques

AbstractMedian sternotomy incision has shown to be a safe and efficacious approach in patients who require thoracic aortic interventions and still represents the gold-standard access. Nevertheless, over the last decade, less invasive techniques have gained wider clinical application in cardiac surgery becoming the first-choice approach to treat heart valve diseases, in experienced centers. The popularization of less invasive techniques coupled with an increased patient demand for less invasive therapies has motivated aortic surgeons to apply minimally invasive approaches to more challenging procedures, such as aortic root replacement and arch repair. However, technical demands and the paucity of available clinical data have still limited the widespread adoption of minimally invasive thoracic aortic interventions. This review aimed to assess and comment on the surgical techniques and the current evidence on mini thoracic aortic surgery.

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Drug, Devices, Technologies, and Techniques for Blood Management in Minimally Invasive and Conventional Cardiothoracic Surgery a Consensus Statement from the International Society for Minimally Invasive Cardiothoracic Surgery (ISMICS) 2011

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0b013e3182747699 ◽

2012 ◽

Vol 7 (4) ◽

pp. 229-241 ◽

Cited By ~ 41

Author(s):

Alan H. Menkis ◽

Janet Martin ◽

Davy C.H. Cheng ◽

David C. Fitzgerald ◽

John J. Freedman ◽

...

Keyword(s):

Cardiac Surgery ◽

Minimally Invasive ◽

Systematic Reviews ◽

Aortic Surgery ◽

Consensus Conference ◽

Cardiothoracic Surgery ◽

Cochrane Library ◽

Evidence Based ◽

Blood Management ◽

Invasive Approach

Objective The objectives of this consensus conference were to evaluate the evidence for the efficacy and safety of perioperative drugs, technologies, and techniques in reducing allogeneic blood transfusion for adults undergoing cardiac surgery and to develop evidence-based recommendations for comprehensive perioperative blood management in cardiac surgery, with emphasis on minimally invasive cardiac surgery. Methods The consensus panel short-listed the potential topics for review from a comprehensive list of potential drugs, devices, technologies, and techniques. The process of short-listing was based on the need to prioritize and focus on the areas of highest importance to surgeons, anesthesiologists, perfusionists, hematologists, and allied health care involved in the management of patients who undergo cardiac surgery whether through the conventional or minimally invasive approach. MEDLINE, Cochrane Library, and Embase databases were searched from their date of inception to May 2011, and supplemental hand searches were also performed. Detailed methodology and search strategies are outlined in each of the subsequently published systematic reviews. In general, all relevant synonyms for drugs (antifibrinolytic, aprotinin, ∊-aminocaproic acid, tranexamic acid [TA], desmopressin, anticoagulants, heparin, antiplatelets, anti-Xa agents, adenosine diphosphate inhibitors, acetylsalicylic acid [ASA], factor VIIa [FVIIa]), technologies (cell salvage, miniaturized cardiopulmonary bypass (CPB) circuits, biocompatible circuits, ultrafiltration), and techniques (transfusion thresholds, minimally invasive cardiac or aortic surgery) were searched and combined with terms for blood, red blood cells, fresh-frozen plasma, platelets, transfusion, and allogeneic exposure. The American Heart Association/American College of Cardiology system was used to label the level of evidence and class of each recommendation. Results and Recommendations Database search identified more than 6900 articles, with 4423 full-text randomized controlled trials assessed for eligibility, and the final 125 systematic reviews and meta-analyses were used in the consensus conference. The results of the consensus conference, including the evidence-based statements and the recommendations, are outlined in the text, with references given for the relevant evidence that formed the basis for the statements and recommendations.

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

Surgical Endoscopy ◽

10.1007/s004649900721 ◽

1998 ◽

Vol 12 (6) ◽

pp. 820-824 ◽

Cited By ~ 12

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

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Euroscore Performance in Minimally Invasive Cardiac Surgery

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000377 ◽

2017 ◽

Vol 12 (4) ◽

pp. 282-286 ◽

Cited By ~ 4

Author(s):

Rafik Margaryan ◽

Marco Moscarelli ◽

Tommaso Gasbarri ◽

Giacomo Bianchi ◽

Enkel Kallushi ◽

...

Keyword(s):

Cardiac Surgery ◽

Confidence Interval ◽

Minimally Invasive ◽

Model Calibration ◽

Minimally Invasive Cardiac Surgery ◽

Operative Risk ◽

Invasive Approach ◽

Logistic Euroscore ◽

Operation Conditions ◽

Minimally Invasive Operation

Objective Prediction of operative risk in adults undergoing cardiac surgery remains a challenge. The European System for Cardiac Operative Risk Evaluation (EuroSCORE) is one of the most commonly used in clinical settings. Recently, the new EuroSCORE II was published attempting to improve the accuracy of risk prediction. We sought to assess the predictive value of EuroSCORE or EuroSCORE II in selected field of minimally invasive cardiac surgery. Methods Patients who underwent cardiac surgery operation with minimally invasive approach from 2007 to 2013 identified from prospective cardiac surgical database. Additional variables included in EuroSCORE II, but not in original EuroSCORE, were retrospectively collected via electronic health records reviewing. The C-statistic was calculated for the EuroSCORE (additive and logistic) and EuroSCORE II. The Hosmer-Lemeshow test was used to assess model calibration by comparing observed and expected morality in number of risk strata. Results There were 39 hospitals deaths (1.6%). A total of 2472 patients were identified from the main database. The mean ± SD logistic EuroSCORE was 7.6 ± 8.3, mean ± SD additive EuroSCORE was 6.1 ± 2.7, and mean ± SD EuroSCORE II was 2.9 ± 4.2. EuroSCORE logistic model performed with substantial accuracy of 0.78, EuroSCORE additive performed with accuracy of 0.78, and EuroSCORE II performed as almost perfect 0.82. Model calibration was poor in EuroSCORE II (χ2 = 17.57, P = 0.02), calibration for logistic EuroSCORE was also poor (χ2 = 140.58, P < 0.01), and additive model also (χ2 = 94.95, P < 0.01). The area under the curve was high in all algorithms; logistic EuroSCORE was 0.78 (95% confidence interval = 0.71–0.85), additive EuroSCORE was 0.79 (95% confidence interval = 0.71–0.86), and EuroSCORE II was 0.82 (95% confidence interval = 0.75–0.89). Conclusions In overall settings, original EuroSCORE and EuroSCORE II perform poorly in minimally invasive operation conditions. Data suggest that EuroSCORE could not be used for estimating operative risks correctly. New risk score should be explored, developed, and implemented for selective minimally invasive cohorts.

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