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Werner P, Winter M, Coti I, Kahrovic A, Andreas M, Haberl T, Zimpfer D, Ehrlich M. State-of-the-Art Review: Advantages and Disadvantages of Femoral Versus Central Cannulation. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2025; 20:148-157. [PMID: 40261087 PMCID: PMC12090206 DOI: 10.1177/15569845251333344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/24/2025]
Abstract
The choice of cannulation technique for cardiopulmonary bypass remains a critical decision in cardiac surgery with direct consequences for intraoperative management and patient outcomes. Central and femoral cannulation represent the 2 dominant approaches, each associated with unique anatomical considerations, hemodynamic implications, and perioperative risks. The correct selection of a cannulation strategy should limit the risk of embolic events and associated complications such as vascular injury and stroke. The purpose of this review is to provide a detailed comparison of central and femoral cannulation techniques, with an emphasis on clinical scenarios and outcomes, recent innovations, and state-of-the-art technology. By critically analyzing current evidence, we aim to offer insights into the optimal cannulation strategy tailored to specific patients.
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Affiliation(s)
- Paul Werner
- Department of Cardiac Surgery, Medical University of Vienna, Austria
| | - Martin Winter
- Department of Cardiac Surgery, Medical University of Vienna, Austria
| | - Iuliana Coti
- Department of Cardiac Surgery, Medical University of Vienna, Austria
| | - Amila Kahrovic
- Department of Cardiac Surgery, Medical University of Vienna, Austria
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, Austria
| | - Thomas Haberl
- Department of Cardiac Surgery, Medical University of Vienna, Austria
| | - Daniel Zimpfer
- Department of Cardiac Surgery, Medical University of Vienna, Austria
| | - Marek Ehrlich
- Department of Cardiac Surgery, Medical University of Vienna, Austria
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Iaccarino A, Giambuzzi I, Galbiati D, Cuko E, Droandi G, Forcina S, Kushta E, Basciu A, Barbone A, Fumero A, Torracca L. Survival and Durability of Minimally Invasive Mitral Valve Repair: Insights from Different Repair Techniques. Med Sci (Basel) 2024; 12:46. [PMID: 39311159 PMCID: PMC11417822 DOI: 10.3390/medsci12030046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Revised: 08/16/2024] [Accepted: 08/29/2024] [Indexed: 09/26/2024] Open
Abstract
This study evaluates the long-term outcomes of minimally invasive mitral valve repair (MIMVR) in patients with degenerative mitral regurgitation, focusing on survival, mitral valve repair failure, and re-operation rates. A cohort of patients undergoing three primary repair techniques-quadrangular resection, edge-to-edge repair, and artificial chordae implantation-was analyzed using time-to-event methods. The overall survival rates at 1, 10, and 20 years were high and comparable among the techniques, indicating effective long-term benefits of MIMVR. However, freedom from recurrence of moderate mitral regurgitation (MR) ≥ 2 was significantly higher in the quadrangular resection and edge-to-edge groups compared to the artificial chordae group. No significant differences were observed for recurrent MR ≥ 3. Re-operation rates were low and similar across all techniques, underscoring the durability of MIMVR. Pre-discharge residual MR ≥ 2 was identified as a strong predictor of long-term repair failure. These findings confirm the effectiveness of MIMVR, with all techniques demonstrating excellent long-term survival and durability.
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Affiliation(s)
- Alessandra Iaccarino
- Cardiovascular Department, UO of Cardiac Surgery of IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy (A.F.)
| | - Ilaria Giambuzzi
- Cardiovascular Department, UO of Cardiac Surgery of IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy (A.F.)
| | - Denise Galbiati
- Cardiovascular Department, UO of Cardiac Surgery of IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy (A.F.)
| | - Enea Cuko
- Cardiovascular Department, UO of Cardiac Surgery of IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy (A.F.)
| | - Ginevra Droandi
- Cardiovascular Department, UO of Cardiac Surgery of IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy (A.F.)
| | - Sara Forcina
- Cardiovascular Department, UO of Cardiac Surgery of IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy (A.F.)
| | - Eraldo Kushta
- IRCCS Foundation Hospital San Matteo, University of Pavia, 27100 Pavia, Italy;
| | - Alessio Basciu
- Cardiovascular Department, UO of Cardiac Surgery of IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy (A.F.)
| | - Alessandro Barbone
- Cardiovascular Department, UO of Cardiac Surgery of IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy (A.F.)
| | - Andrea Fumero
- Cardiovascular Department, UO of Cardiac Surgery of IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy (A.F.)
| | - Lucia Torracca
- Cardiovascular Department, UO of Cardiac Surgery of IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy (A.F.)
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Liu Z, Maimaitiaili A, Ma X, Dong S, Wei W, Wang Q, Chen Q, Liu J, Guo Z. Initial experience and favorable outcomes on cannulation strategies and surgical platform construction in fully video-assisted thoracoscopic cardiac surgery. Front Cardiovasc Med 2024; 11:1414333. [PMID: 39175634 PMCID: PMC11338890 DOI: 10.3389/fcvm.2024.1414333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 07/29/2024] [Indexed: 08/24/2024] Open
Abstract
Background Minimally invasive cardiac surgery offers numerous advantages that patients and surgeons desire. This surgical platform encompasses cannulation strategies for cardiopulmonary bypass, optimal surgical access points, and high-quality visualization techniques. Traditional peripheral cannulation methods, though convenient, possess inherent limitations and carry the potential for complications such as retrograde dissection, stroke, or neurologic sequelae. Conversely, central cannulation may be ideally suited to circumvent the disadvantages above. Fully video-assisted thoracoscopy cardiac surgery represents a state-of-the-art platform, offering surgeons an unparalleled surgical view. This analysis aimed to delineate the efficacy and safety of transthoracic central cannulation strategies and the surgical platform during fully video-assisted thoracoscopy cardiac surgery. Methods Between October 2022 and February 2024, we identified a cohort of 85 consecutive patients with cardiopulmonary bypass undergoing fully video-assisted thoracoscopy cardiac surgery at our institutions. The patients' mean age was 41.09 ± 14.01 years, ranging from 18 to 75 years. The mean weight was 64.34 ± 10.59 kg (ranging from 49 to 103 kg). Congenital heart disease repair accounted for the highest proportion, with 43 cases (50.59%). Mitral valve surgery and left atrium Myxoma resections accounted for 29.41%. Specifically, this included 14 mitral valve repairs, five mitral valve replacements, and six left atrium myxoma resections. Aortic valve replacements constitute 20% of all cases. Results A total of 85 adult patients underwent fully video-assisted thoracoscopy cardiac surgery. The average CPB time was 83.26 ± 28.26 min, while the aortic cross-clamp time averaged 51.87 ± 23.91 min. The total operation time (skin to skin) averaged 173.8 ± 37.08 min. The mean duration of mechanical ventilation was 5.58 ± 3.43 h, ICU stay was 20.04 ± 2.83 h (ranging from 15.5 to 34 h), and postoperative hospital stay was 5.55 ± 0.87 days. No patients required conversion to thoracotomy and unplanned reoperations due to various reasons. There were no in-hospital deaths, strokes, myocardial infarctions, aortic dissections, or renal failure. No patient developed wound soft tissue infection. Conclusions Fully video-assisted thoracoscopy cardiac surgery utilizing central cannulation strategies is a reliable, cost-effective platform with a low risk of complications and a potential solution for patients facing contraindications for peripheral cannulation.
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Affiliation(s)
- Zihou Liu
- Department of Cardiovascular Surgery, Clinical School of Thoracic, Tianjin Medical University, Tianjin, China
- Department of Cardiovascular Surgery, Chest Hospital, Tianjin University, Tianjin, China
- Department of Cardiothoracic Surgery, Renmin Hospital of Hotan Prefecture, Xinjiang Uygur Autonomous Region, Xinjiang, China
| | - Abulizi Maimaitiaili
- Department of Cardiothoracic Surgery, Renmin Hospital of Hotan Prefecture, Xinjiang Uygur Autonomous Region, Xinjiang, China
| | - Xiaozhong Ma
- Department of Cardiovascular Surgery, Clinical School of Thoracic, Tianjin Medical University, Tianjin, China
- Department of Cardiovascular Surgery, Chest Hospital, Tianjin University, Tianjin, China
| | - Shuangfeng Dong
- Department of Cardiothoracic Surgery, Renmin Hospital of Hotan Prefecture, Xinjiang Uygur Autonomous Region, Xinjiang, China
| | - Wei Wei
- Department of Cardiothoracic Surgery, Renmin Hospital of Hotan Prefecture, Xinjiang Uygur Autonomous Region, Xinjiang, China
| | - Qiang Wang
- Department of Cardiovascular Surgery, Clinical School of Thoracic, Tianjin Medical University, Tianjin, China
- Department of Cardiovascular Surgery, Chest Hospital, Tianjin University, Tianjin, China
| | - Qingliang Chen
- Department of Cardiovascular Surgery, Clinical School of Thoracic, Tianjin Medical University, Tianjin, China
- Department of Cardiovascular Surgery, Chest Hospital, Tianjin University, Tianjin, China
| | - Jianshi Liu
- Department of Cardiovascular Surgery, Clinical School of Thoracic, Tianjin Medical University, Tianjin, China
- Department of Cardiovascular Surgery, Chest Hospital, Tianjin University, Tianjin, China
| | - Zhigang Guo
- Department of Cardiovascular Surgery, Clinical School of Thoracic, Tianjin Medical University, Tianjin, China
- Department of Cardiovascular Surgery, Chest Hospital, Tianjin University, Tianjin, China
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Taghizadeh-Waghefi A, Arzt S, Wenzel L, Petrov A, Wilbring M, Matschke K, Kappert U, Alexiou K. Right Anterior versus Right Transaxillary Access for Minimally Invasive Aortic Valve Replacement: A Propensity Matched Competitive Analysis. J Clin Med 2024; 13:985. [PMID: 38398297 PMCID: PMC10889463 DOI: 10.3390/jcm13040985] [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: 01/19/2024] [Revised: 02/03/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
(1) Background: Right anterior thoracotomy (RAT-AVR) has been the sole established sternum-sparing technique for minimally invasive aortic valve replacement (MICS-AVR) thus far. Nevertheless, transaxillary access, known as Minimally Invasive Cardiac LATeral Surgery (MICLATS-AVR), represents the latest and innovative advancement in sternum-sparing MICS-AVR access routes. In this study, procedural and clinical outcomes of a substantial transaxillary MICS-AVR cohort are compared to those of a RAT-AVR control group; (2) Patients and Methods: This retrospective study included 918 consecutive patients who underwent MICS-AVR at our facility between 2014 and 2022. This cohort was divided into two surgical access-related groups: RAT-AVR (n = 492) and MICLATS-AVR (n = 426). Procedural data, operative morbidity, and mortality were compared between groups. Further analysis was performed using propensity score matching; (3) Results: After matching, 359 pairs of patients were included and analyzed. There were no notable differences observed between the two groups regarding major adverse cardio-cerebral events. Despite longer cardiopulmonary bypass time in the MICLATS-AVR group (63.1 ± 20.4 min vs. 66.4 ± 18.2 min; p ≤ 0.001) the skin-to-skin time (129.4 ± 35.9 min. vs. 126.5 ± 29.8 min.; p = 0.790) and the aortic cross-clamp time was comparable between both groups (41.9 ± 13.3 min. vs. 43.5 ± 14.4 min.; p = 0.182). The overall hospital stay was significantly shorter in the MICLATS-AVR cohort (9.7 ± 5.2 days vs. 9.2 ± 4.5 days; p = 0.01). Both groups were comparable in terms of postoperative morbidities. However, significantly lower rates of postoperative impaired wound healing were noted in the MICLATS-AVR group (11.7% vs. 3.9%, p < 0.001); (4) Conclusions: In comparing MICLATS-AVR and RAT-AVR, our study found MICLATS-AVR to be at least as safe and time-efficient as RAT-AVR, with no significant differences in MACCE. MICLATS-AVR showed a shorter hospital stay and lower postoperative wound issues, indicating its feasibility and safety as an alternative. Notably, MICLATS-AVR is sternum- and bone-sparing, preserving the right mammary artery, and facilitates combined procedures like multiple valve surgeries.
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Affiliation(s)
- Ali Taghizadeh-Waghefi
- Medical Faculty “Carl Gustav Carus”, TU Dresden, 01307 Dresden, Germany; (S.A.); (A.P.); (M.W.); (K.M.); (U.K.); (K.A.)
- Center for Minimally Invasive Cardiac Surgery, University Heart Center Dresden, 01307 Dresden, Germany
| | - Sebastian Arzt
- Medical Faculty “Carl Gustav Carus”, TU Dresden, 01307 Dresden, Germany; (S.A.); (A.P.); (M.W.); (K.M.); (U.K.); (K.A.)
- Center for Minimally Invasive Cardiac Surgery, University Heart Center Dresden, 01307 Dresden, Germany
| | - Lisa Wenzel
- Medical Faculty “Carl Gustav Carus”, TU Dresden, 01307 Dresden, Germany; (S.A.); (A.P.); (M.W.); (K.M.); (U.K.); (K.A.)
- Center for Minimally Invasive Cardiac Surgery, University Heart Center Dresden, 01307 Dresden, Germany
| | - Asen Petrov
- Medical Faculty “Carl Gustav Carus”, TU Dresden, 01307 Dresden, Germany; (S.A.); (A.P.); (M.W.); (K.M.); (U.K.); (K.A.)
- Center for Minimally Invasive Cardiac Surgery, University Heart Center Dresden, 01307 Dresden, Germany
| | - Manuel Wilbring
- Medical Faculty “Carl Gustav Carus”, TU Dresden, 01307 Dresden, Germany; (S.A.); (A.P.); (M.W.); (K.M.); (U.K.); (K.A.)
- Center for Minimally Invasive Cardiac Surgery, University Heart Center Dresden, 01307 Dresden, Germany
| | - Klaus Matschke
- Medical Faculty “Carl Gustav Carus”, TU Dresden, 01307 Dresden, Germany; (S.A.); (A.P.); (M.W.); (K.M.); (U.K.); (K.A.)
- Center for Minimally Invasive Cardiac Surgery, University Heart Center Dresden, 01307 Dresden, Germany
| | - Utz Kappert
- Medical Faculty “Carl Gustav Carus”, TU Dresden, 01307 Dresden, Germany; (S.A.); (A.P.); (M.W.); (K.M.); (U.K.); (K.A.)
- Center for Minimally Invasive Cardiac Surgery, University Heart Center Dresden, 01307 Dresden, Germany
| | - Konstantin Alexiou
- Medical Faculty “Carl Gustav Carus”, TU Dresden, 01307 Dresden, Germany; (S.A.); (A.P.); (M.W.); (K.M.); (U.K.); (K.A.)
- Center for Minimally Invasive Cardiac Surgery, University Heart Center Dresden, 01307 Dresden, Germany
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Aidamirov IA, Evseev EP, Balakin EV, Malakhova MV, Popov SO. [CT in planning of heart valve surgery through minithoracotomy]. Khirurgiia (Mosk) 2024:127-133. [PMID: 39665357 DOI: 10.17116/hirurgia2024122127] [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] [Indexed: 12/13/2024]
Abstract
Computed tomography (CT) is an indispensable tool for preoperative planning in minimally invasive cardiac surgery. In this article, the authors estimate significance of CT for analysis of anatomy and pathology of cardiovascular system. CT provides surgeons with high-quality images and assessment of structural features in the areas of subsequent manipulations. These aspects are essential for individualized surgical plan. CT significantly reduces the risk of postoperative complications due to better understanding of anatomical features. Moreover, CT contributes to safe minithoracotomy. Thus, CT is essential in preoperative planning. This method improves postoperative outcomes and minimizes surgical risks.
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Affiliation(s)
- I A Aidamirov
- Petrovsky National Research Center of Surgery, Moscow, Russia
| | - E P Evseev
- Petrovsky National Research Center of Surgery, Moscow, Russia
| | - E V Balakin
- Petrovsky National Research Center of Surgery, Moscow, Russia
| | - M V Malakhova
- Petrovsky National Research Center of Surgery, Moscow, Russia
| | - S O Popov
- Petrovsky National Research Center of Surgery, Moscow, Russia
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Faerber G, Mukharyamov M, Doenst T. Is There a Future for Minimal Access and Robots in Cardiac Surgery? J Cardiovasc Dev Dis 2023; 10:380. [PMID: 37754809 PMCID: PMC10531980 DOI: 10.3390/jcdd10090380] [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: 07/31/2023] [Revised: 08/27/2023] [Accepted: 08/29/2023] [Indexed: 09/28/2023] Open
Abstract
Minimally invasive techniques in cardiac surgery have found increasing use in recent years. Both patients and physicians often associate smaller incisions with improved outcomes (i.e., less risk, shorter hospital stay, and a faster recovery). Videoscopic and robotic assistance has been introduced, but their routine use requires specialized training and is associated with potentially longer operating times and higher costs. Randomized evidence is scarce and transcatheter treatment alternatives are increasing rapidly. As a result, the concept of minimally invasive cardiac surgery may be viewed with skepticism. In this review, we examine the current status and potential future perspectives of minimally invasive and robotic cardiac surgery.
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Affiliation(s)
| | | | - Torsten Doenst
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University, Am Klinikum 1, 07747 Jena, Germany
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Johnston DR, Gillinov AM. Is there a "one size fits all" minimally invasive approach for valve surgery? Ann Thorac Surg 2021; 114:727. [PMID: 34780771 DOI: 10.1016/j.athoracsur.2021.09.073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 09/29/2021] [Indexed: 11/01/2022]
Affiliation(s)
- Douglas R Johnston
- Cleveland Clinic, Thoracic and Cardiovascular Surgery, 9500, Euclid Ave, J-4-480, Cleveland, OH 44195.
| | - A Marc Gillinov
- Cleveland Clinic, Thoracic and Cardiovascular Surgery, 9500, Euclid Ave, J-4-480, Cleveland, OH 44195
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Chen Y, Chen LW, Dai XF, Huang XS. Open Seldinger-guided peripheral femoro-femoral cannulation technique for totally endoscopic cardiac surgery. J Cardiothorac Surg 2021; 16:199. [PMID: 34294106 PMCID: PMC8296695 DOI: 10.1186/s13019-021-01584-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 07/10/2021] [Indexed: 12/29/2022] Open
Abstract
Background The cannulation technique used in totally endoscopic cardiac surgery has a significant impact on the overall prognosis of patients. However, there are no large cohort studies to discuss it. Here we report on our research of using open Seldinger-guided technique to establish femoro-femoral cardiopulmonary bypass during totally endoscopic cardiac surgery and evaluate its safety and efficacy. Methods The institutional database from 2017 to 2020 was retrospectively reviewed to find cases in which totally endoscopic cardiac surgery was performed. We identified 214 consecutive patients who underwent totally endoscopic cardiac surgery with peripheral femoro-femoral cannulation. All patients underwent femoral artery cannulation. Of these, 201 were cannulated in the femoral vein and 13 were cannulated in the femoral vein combined with internal jugular cannulation. The technique involves surgically exposing the femoral vessel, setting up purse-string over the vessels and then inserting a guidewire into the femoral vessel without a vascular incision, followed by exchange of the guidewire with a cannula. Results Surgery indications included mitral valve disease in 82.71% (177/214), atrial septal defect in 11.68% (25/214) and tricuspid regurgitation in the remaining 5.61% (12/214). Hospital survival was 98.60% (211/214). There were no cases of stroke and postoperative limb ischaemia. No femoral vessel injuries or wound infections was observed. No late pseudoaneurysms were evident. Conclusion The open Seldinger-guided femoro-femoral cannulation technique is effective and safe. We highly recommend this technique, given its safety, simplicity and speed under direct vision. The limited manipulation of the vessels under direct vision minimizes the risk of local complications. Supplementary Information The online version contains supplementary material available at 10.1186/s13019-021-01584-x.
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Affiliation(s)
- Yi Chen
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, China.,Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, China
| | - Liang-Wan Chen
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Xiao-Fu Dai
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Xue-Shan Huang
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, China. .,Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, China.
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Ghoreishi M, Thourani VH, Badhwar V, Massad M, Svensson L, Taylor BS, Pasrija C, Gammie JS, Jacobs JP, Cox M, Grau-Sepulveda M, Brennan M, Griffith BP, Milliken JC, Abdelhady K, Kon Z. Less-Invasive Aortic Valve Replacement: Trends and Outcomes From The Society of Thoracic Surgeons Database. Ann Thorac Surg 2021; 111:1216-1223. [DOI: 10.1016/j.athoracsur.2020.06.039] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 06/01/2020] [Accepted: 06/08/2020] [Indexed: 10/23/2022]
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10
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Huang LC, Xu QC, Chen DZ, Dai XF, Chen LW. Peripheral vascular complications following totally endoscopic cardiac surgery. J Cardiothorac Surg 2021; 16:38. [PMID: 33743734 PMCID: PMC7981916 DOI: 10.1186/s13019-021-01417-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 03/10/2021] [Indexed: 11/10/2022] Open
Abstract
Background Clinical application of minimally invasive cardiac surgery has increased annually. Cardiopulmonary bypass is established by peripheral cannulation during minimally invasive cardiac surgery. The methodology of peripheral cannulation has unique characteristics, which have associated risks and complications. Few studies have been conducted on this topic. In this study, we focused on complications of peripheral cannulation in totally endoscopic cardiac surgery. Methods Patients who underwent totally endoscopic cardiac surgery with cardiopulmonary bypass established by peripheral cannulation at our institution between January 2019 and June 2020 were reviewed. Specific cannulation strategies and related cannulation complications were noted. Results One hundred forty-eight patients underwent totally endoscopic cardiac surgery. One hundred forty-eight cannulations were performed in the femoral artery and vein, and eleven were performed in the internal jugular vein (combined with the femoral vein). The median size of the femoral artery cannula was 22Fr, and that of the venous canula was 24Fr. One patient died of retroperitoneal haematoma due to femoral artery injury. Three patients had postoperative lower limb oedema. One patient had a postoperative diagnosis of femoral vein thrombosis. Conclusions Different from cannulation in patients with aortic dissection and aneurysms, femoral artery cannulation is safe in totally endoscopic cardiac surgery. Venous cannulation is characterized by a large-bore venous cannula and a short period of use. There are few reports about complications of venous cannulation. The main complication in this study was mechanical injury, and the key to preventing this injury is meticulous manipulation during surgery.
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Affiliation(s)
- Ling-Chen Huang
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001, China.,Fujian Key Laboratory of Cardio-thoracic Surgery (Fujian Medical University), Fuzhou, China
| | - Qi-Chen Xu
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001, China
| | - Dao-Zhong Chen
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001, China
| | - Xiao-Fu Dai
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001, China
| | - Liang-Wan Chen
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001, China. .,Fujian Key Laboratory of Cardio-thoracic Surgery (Fujian Medical University), Fuzhou, China.
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Immohr MB, Sugimura Y, Kröpil P, Aubin H, Minol JP, Albert A, Boeken U, Lichtenberg A, Akhyari P. Impact of standardized computed tomographic angiography for minimally invasive mitral and tricuspid valve surgery. J Cardiothorac Surg 2021; 16:34. [PMID: 33743765 PMCID: PMC7981880 DOI: 10.1186/s13019-021-01400-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 03/08/2021] [Indexed: 11/25/2022] Open
Abstract
Background Femoral cannulation for extracorporeal circulation (ECC) is a standard procedure for minimally invasive cardiac surgery (MICS) of the atrio-ventricular valves. Vascular pathologies may cause serious complications. Preoperative computed tomography-angiography (CT-A) of the aorta, axillary and iliac arteries was implemented at our department. Methods Between July 2017 and December 2018 all MICS were retrospectively reviewed (n = 143), and divided into 3 groups. Results In patients without CT (n = 45, 31.5%) ECC was applied via femoral arteries (91.1% right, 8.9% left). Vascular related complications (dissection, stroke, coronary and visceral ischemia, related in-hospital death) occurred in 3 patients (6.7%). In patients with non-contrast CT (n = 35, 24.5%) only femoral cannulation was applied (94.3% right) with complications in 4 patients (11.4%). CT-angiography (n = 63, 44.1%) identified 12 patients (19.0%) with vulnerable plaques, 7 patients (11.1%) with kinking of iliac vessels, 41 patients (65.1%) with multiple calcified plaques and 5 patients (7.9%) with small femoral artery diameter (d ≤ 6 mm). In 7 patients (11.1%) pathologic findings led to alternative cannulation via right axillary artery, additional 4 patients (6.3%) were cannulated via left femoral artery. Only 2 patients (3.2%) suffered from complications. Conclusions CT-A identifies vascular pathologies otherwise undetectable in routine preoperative preparation. A standardized imaging protocol may help to customize the operative strategy.
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Affiliation(s)
- Moritz B Immohr
- Department of Cardiac Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Yukiharu Sugimura
- Department of Cardiac Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Patric Kröpil
- Department of Radiology, BG Klinikum Duisburg, Großenbaumer Allee 250, 47249, Duisburg, Germany
| | - Hug Aubin
- Department of Cardiac Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Jan-Philipp Minol
- Department of Vascular and Endovascular Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Alexander Albert
- Department of Cardiac Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Udo Boeken
- Department of Cardiac Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Artur Lichtenberg
- Department of Cardiac Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany.
| | - Payam Akhyari
- Department of Cardiac Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
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Tamagnini G, Biondi R, Giglio MD. Aortic Valve Replacement Via Right Anterior Mini-Thoracotomy: the Conventional Procedure Performed Through a Smaller Incision. Braz J Cardiovasc Surg 2021; 36:120-124. [PMID: 33594866 PMCID: PMC7918393 DOI: 10.21470/1678-9741-2020-0165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Minimally invasive aortic valve replacement has gained consent due to its good results in terms of minimized surgical trauma, faster rehabilitation, pain control and patient compliance. In our experience, we have tried to replicate the conventional and gold standard approach through a smaller incision. Sparing the right internal thoracic artery, avoiding rib fractures and performing total central cannulation is important to make this procedure minimally invasive from a biological point of view too. In addition, the total central cannulation is pivotal to simplify perfusion and drainage. Moreover, a complete step-by-step procedure optimization and-when possible-the use of sutureless prosthesis help to reduce the cross-clamping and perfusion times. After more than 1000 right anterior thoracotomy (RAT) aortic valve replacements, we have found tips and tricks to make our technique more effective.
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Affiliation(s)
| | - Raoul Biondi
- Department of Cardiac Surgery, Villa Torri Hospital, Bologna, Italy
| | - Mauro Del Giglio
- Department of Cardiac Surgery, Villa Torri Hospital, Bologna, Italy
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Del Giglio M, Tamagnini G, Biondi R, Di Mauro M. A simpler minimal. J Card Surg 2020; 35:3666. [DOI: 10.1111/jocs.15001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 07/27/2020] [Indexed: 11/27/2022]
Affiliation(s)
| | | | - Raoul Biondi
- Cardiovascular Department Villa Torri Hospital Bologna Italy
| | - Michele Di Mauro
- Cardiothoracic and Vascular Department Maastricht University Medical Center Maastricht The Netherlands
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Van Praet KM, Kofler M, Unbehaun A, Hommel M, Jacobs S, Falk V, Kempfert J. Reply to Del Giglio, Tamagnini, Biondi, and Di Mauro. J Card Surg 2020; 35:3667-3670. [DOI: 10.1111/jocs.14998] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 08/25/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Karel M. Van Praet
- Department of Cardiothoracic and Vascular Surgery German Heart Center Berlin Berlin Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin Berlin Germany
| | - Markus Kofler
- Department of Cardiothoracic and Vascular Surgery German Heart Center Berlin Berlin Germany
| | - Axel Unbehaun
- Department of Cardiothoracic and Vascular Surgery German Heart Center Berlin Berlin Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin Berlin Germany
| | - Matthias Hommel
- Institute for Anesthesiology, German Heart Center Berlin Berlin Germany
| | - Stephan Jacobs
- Department of Cardiothoracic and Vascular Surgery German Heart Center Berlin Berlin Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery German Heart Center Berlin Berlin Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin Berlin Germany
- Department of Cardiothoracic Surgery Charité – Universitätsmedizin Berlin Berlin Germany
- Berlin Institute of Health Berlin Germany
- Department of Health Sciences, ETH Zürich Translational Cardiovascular Technologies Zurich Switzerland
| | - Jörg Kempfert
- Department of Cardiothoracic and Vascular Surgery German Heart Center Berlin Berlin Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin Berlin Germany
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15
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Burns DJ, Birla R, Vohra HA. Clinical outcomes associated with retrograde arterial perfusion in minimally invasive mitral valve surgery: a systematic review. Perfusion 2020; 36:11-20. [PMID: 32519587 DOI: 10.1177/0267659120929181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Given several reports of an increased neurologic risk with retrograde arterial perfusion in minimally invasive mitral valve surgery, we sought to identify and synthesize the best available evidence on the influence of perfusion strategy on post-operative clinical outcomes in this population. METHODS A systematic search of PubMed, EMBASE, MEDLINE, and Cochrane library databases was performed to identify publications comparing clinical outcomes associated with antegrade and retrograde arterial perfusion in minimally invasive mitral valve surgery. Pre-specified outcomes of interest were neurologic events, mortality, and renal failure. The search was performed by two independent reviewers, with data abstraction following. RESULTS Seven observational studies were included in this review, with a total patient population of 5,385. Six were retrospective cohort in design, with a single small prospective cohort study identified. When available, adjusted publication-specific risk estimates were abstracted and included preferentially over unadjusted or reviewer-derived risk estimates. Meta-analysis was felt to be heavily flawed in the context of few small studies identified and was not performed. In adjusted estimates, there appeared to be an increased risk of neurologic complications with retrograde arterial perfusion. There was a null pattern apparent between arterial perfusion strategy and each of 30-day mortality and renal failure. CONCLUSION Retrograde arterial perfusion in minimally invasive mitral valve surgery may be associated with an increased risk of neurologic events, without affecting the risk of 30-day mortality or renal failure. Although these patterns were identified, an overall paucity of evidence justifies further study.
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Affiliation(s)
- Daniel Jp Burns
- Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Rashmi Birla
- Cardiac Surgery, Freeman Hospital, Newcastle upon Tyne, UK
| | - Hunaid A Vohra
- Cardiac Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
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Percy E, Hirji SA, Yazdchi F, McGurk S, Kiehm S, Cook R, Kaneko T, Shekar P, Pelletier MP. Long-Term Outcomes of Right Minithoracotomy Versus Hemisternotomy for Mitral Valve Repair. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2020; 15:74-80. [PMID: 31957524 DOI: 10.1177/1556984519891966] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Minimally invasive mitral valve repair has been increasingly adopted. Right minithoracotomy (RT) and lower hemisternotomy (HS) have each been associated with improved short-term outcomes; however, these approaches have not been directly compared to each other. The aim of this study was to compare long-term survival and durability of 2 minimally invasive approaches to mitral repair. METHODS We retrospectively identified all isolated mitral repairs performed via RT or HS between October 1997 and June 2018; 100 RT cases and 719 HS cases were included. Outcomes of interest were postoperative complications, long-term survival, and freedom from mitral reoperation. A Cox proportional hazard model was used to compare RT and HS to a reference cohort of full-sternotomy cases. Total observation time was 9,901 patient-years and mean follow-up time was 12.2 years. RESULTS Mean age was 58±12 years in the RT group and 56±13 years in the HS group (P = 0.2). The RT group had longer bypass (143 minutes vs. 112 minutes; P < 0.001) and cross-clamp times (99 minutes vs. 78 minutes; P < 0.001) compared with the HS group. There were no differences in operative mortality or 30-day outcomes. Survival at 5, 10, and 15 years was 99% (96-100), 92% (85-100), and 69% (30-100) in the RT group and 98% (97-99), 92% (90-94), and 89% (86-92) for HS (P < 0.9). There were no differences in risk-adjusted survival between RT, HS and full sternotomy. No long-term mitral reoperations occurred in the RT group and 8 (1%) occurred in the HS group (P < 0.50). CONCLUSIONS Minimally invasive mitral valve repair can be performed safely through RT or HS with excellent survival and durability at 15 years.
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Affiliation(s)
- Edward Percy
- 8166 Division of Cardiovascular Surgery, University of British Columbia, Vancouver, BC, Canada.,1861 Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sameer A Hirji
- 1861 Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Farhang Yazdchi
- 1861 Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Siobhan McGurk
- 1861 Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Spencer Kiehm
- 1861 Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Richard Cook
- 8166 Division of Cardiovascular Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Tsuyoshi Kaneko
- 1861 Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Prem Shekar
- 1861 Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Marc P Pelletier
- 114516 Division of Cardiac Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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Nakajima H, Takazawa A, Tounaga C, Yoshitake A, Tochii M, Hayashi J, Kaneyuki D, Asakura T, Iguchi A. Comparison of the Efficacy of Transthoracic Cannulation into the Ascending Aorta Versus Femoral Artery Cannulation in Minimally Invasive Cardiac Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2019; 14:537-544. [DOI: 10.1177/1556984519879123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective To delineate the efficacy and safety of transthoracic cannulation to the ascending aorta through a right pleural cavity during minimally invasive cardiac surgery (MICS). Methods We retrospectively assessed the records of 104 patients who underwent MICS in our institution between December 2011 and December 2018. Procedures included mitral valve repair (88 patients), aortic valve replacement (8 patients), atrial septal defect closure (6 patients), and myxoma resection (2 patients). Aortic valve replacements were performed through the third intercostal space (ICS), whereas the other procedures were mainly performed through the fourth ICS. The femoral group comprised 60 patients in whom an artificial graft was anastomosed to the femoral artery and 4 who underwent cannulation into the femoral artery. The aorta group comprised 40 patients in whom transthoracic cannulation was performed through the second or third ICS, separate from the main skin incision. Results No mortality or critical complications were associated with cardiopulmonary bypass. Perfusion pressure measured at outflow of the artificial lung (224 ± 43 vs. 190 ± 42; P < 0.001) and pump pressure measured at the outflow of the pump (293 ± 50 vs. 255 ± 57; P < 0.001) were significantly higher in the femoral group than in the aorta group. The skin incision lengths were similar (56.9 ± 6.9 vs. 55.1 ± 6.0 mm; P = 0.107). Conclusions Transthoracic cannulation into the ascending aorta is reliable and can be safely performed. The possible risks associated with peripheral cannulation and retrograde perfusion can be avoided thereafter.
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Affiliation(s)
- Hiroyuki Nakajima
- Department of Cardiovascular Surgery, Saitama Medical University, International Medical Centre, Hidaka, Japan
| | - Akitoshi Takazawa
- Department of Cardiovascular Surgery, Saitama Medical University, International Medical Centre, Hidaka, Japan
| | - Chiho Tounaga
- Department of Cardiovascular Surgery, Saitama Medical University, International Medical Centre, Hidaka, Japan
| | - Akihiro Yoshitake
- Department of Cardiovascular Surgery, Saitama Medical University, International Medical Centre, Hidaka, Japan
| | - Masato Tochii
- Department of Cardiovascular Surgery, Saitama Medical University, International Medical Centre, Hidaka, Japan
| | - Jun Hayashi
- Department of Cardiovascular Surgery, Saitama Medical University, International Medical Centre, Hidaka, Japan
| | - Daisuke Kaneyuki
- Department of Cardiovascular Surgery, Saitama Medical University, International Medical Centre, Hidaka, Japan
| | - Toshihisa Asakura
- Department of Cardiovascular Surgery, Saitama Medical University, International Medical Centre, Hidaka, Japan
| | - Atsushi Iguchi
- Department of Cardiovascular Surgery, Saitama Medical University, International Medical Centre, Hidaka, Japan
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Patel NC, Hemli JM, Seetharam K, Graver LM, Brinster DR, Pirelli L, Scheinerman SJ, Hartman AR. Reoperative mitral valve surgery via sternotomy or right thoracotomy: A propensity‐matched analysis. J Card Surg 2019; 34:976-982. [DOI: 10.1111/jocs.14170] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 05/28/2019] [Accepted: 06/22/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Nirav C. Patel
- Department of Cardiovascular & Thoracic Surgery, Northwell HealthLenox Hill Hospital New York New York
| | - Jonathan M. Hemli
- Department of Cardiovascular & Thoracic Surgery, Northwell HealthLenox Hill Hospital New York New York
| | - Karthik Seetharam
- Department of Cardiovascular & Thoracic Surgery, Northwell HealthLenox Hill Hospital New York New York
| | - L. Michael Graver
- Department of Cardiothoracic Surgery, Northwell HealthNorth Shore University Hospital Manhasset New York
| | - Derek R. Brinster
- Department of Cardiovascular & Thoracic Surgery, Northwell HealthLenox Hill Hospital New York New York
| | - Luigi Pirelli
- Department of Cardiovascular & Thoracic Surgery, Northwell HealthLenox Hill Hospital New York New York
| | - S. Jacob Scheinerman
- Department of Cardiovascular & Thoracic Surgery, Northwell HealthLenox Hill Hospital New York New York
| | - Alan R. Hartman
- Department of Cardiothoracic Surgery, Northwell HealthNorth Shore University Hospital Manhasset New York
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Mkalaluh S, Szczechowicz M, Dib B, Sabashnikov A, Szabo G, Karck M, Weymann A. Early and long-term results of minimally invasive mitral valve surgery through a right mini-thoracotomy approach: a retrospective propensity-score matched analysis. PeerJ 2018; 6:e4810. [PMID: 29868261 PMCID: PMC5978402 DOI: 10.7717/peerj.4810] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Accepted: 04/30/2018] [Indexed: 11/30/2022] Open
Abstract
Background Minimally invasive mitral valve surgery (MVS) via right mini-thoracotomy has recently attracted a lot of attention. Minimally invasive MVS shows postoperative results that are comparable to those of conventional MVS through the median sternotomy as per various earlier studies. Methods Between 2000 and 2016, a total of 669 isolated mitral valve procedures for isolated mitral valve regurgitation were performed. A propensity score-matched analysis was generated for the elimination of the differences in relevant preoperative risk factors between the cohorts and included 227 patient pairs. Only degenerative mitral valve regurgitation was included. The aim of our study was to examine if the minimally MVS is superior to the conventional approach through sternotomy based on a retrospective propensity-matched analysis. The primary endpoints were early mortality and long-term survival. The secondary endpoints included postoperative complications. Results The in-hospital mortality rate was significantly higher within the conventional sternotomy cohort (3.1%, n = 7 vs 0.4%, n = 1 for the minimally invasive cohort; p = 0.032). The incidence of stroke and exploration for bleeding was comparable. In contrast, the necessity for dialysis was significantly lower in the minimally invasive cohort (p = 0.044). Postoperative pain was not significantly lower in the minimally invasive MVS cohort (p = 0.862). While patients who underwent minimally invasive MVS experienced longer bypass and cross-clamp times, their lengths of stay in the intensive care unit and in the hospital, did not differ from the conventionally operated collective (p = 0.779 and p = 0.516), respectively. The mitral valve repair rate of 81.1% in the minimally invasive cohort was significantly superior to that of the conventional approach, which was 46.3% (p < 0.0001). The one-, five-, and 10-year survival rates were significantly higher in the minimally invasive cohort compared to the conventional approach (96%, 90%, and 84% vs. 89%, 85%, and 70%; log rank p = 0.004). Conclusion Despite prolonged cardiopulmonary bypass and cross-clamping times, the minimally invasive MVS may be considered a safe approach that is equivalent to standard median sternotomy with lower early mortality and superior long-term survival.
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Affiliation(s)
- Sabreen Mkalaluh
- Department of Cardiac Surgery, Heart and Marfan Center-University of Heidelberg, Heidelberg, Germany
| | - Marcin Szczechowicz
- Department of Cardiac Surgery, Heart and Marfan Center-University of Heidelberg, Heidelberg, Germany
| | - Bashar Dib
- Department of Cardiac Surgery, Heart and Marfan Center-University of Heidelberg, Heidelberg, Germany
| | - Anton Sabashnikov
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Cologne, Germany
| | - Gabor Szabo
- Department of Cardiac Surgery, Heart and Marfan Center-University of Heidelberg, Heidelberg, Germany
| | - Matthias Karck
- Department of Cardiac Surgery, Heart and Marfan Center-University of Heidelberg, Heidelberg, Germany
| | - Alexander Weymann
- Department of Cardiac Surgery, Heart and Marfan Center-University of Heidelberg, Heidelberg, Germany
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Murzi M, Cerillo AG, Gasbarri T, Margaryan R, Kallushi E, Farneti P, Solinas M. Antegrade and retrograde perfusion in minimally invasive mitral valve surgery with transthoracic aortic clamping: a single-institution experience with 1632 patients over 12 years. Interact Cardiovasc Thorac Surg 2017; 24:363-368. [PMID: 28040754 DOI: 10.1093/icvts/ivw370] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 09/19/2016] [Indexed: 11/14/2022] Open
Abstract
Objectives The aim of the present study was to evaluate the impact of a retrograde arterial perfusion (RAP) strategy versus an antegrade arterial perfusion (AAP) strategy in a consecutive, large cohort of patients who underwent minimally invasive mitral valve surgery with transthoracic aortic clamping through a right minithoracotomy. Methods Between 2003 and 2015, 1632 consecutive patients underwent first-time minimally invasive mitral valve surgery with transthoracic aortic clamping at our institution; 141 (8.6%) of these patients received retrograde perfusion with femoral artery cannulation, whereas 1421 (91.4%) received antegrade perfusion with ascending aorta cannulation. Logistic regression was used to evaluate outcomes and risk factors for death and stroke between groups. Results The overall frequency of 30-day mortality was 0.7% (13/1632) and was similar between groups (retrograde arterial perfusion RAP 0.7% vs AAP 0.8%; P = 0.903). The overall postoperative stroke rate was 1.3% (22/1632). The stroke rate was significantly higher in patients receiving retrograde perfusion (3.5% vs 1.1%; P = 0.005). Risk factors for death were advanced age (odds ratio (OR) = 1.3; P = 0.004), mitral valve replacement (OR = 3.9; P = 0.05), emergent procedure (OR = 3.4; P = 0.014) and conversion to sternotomy (OR = 3.7; P = 0.001). Multivariable regression analysis revealed that retrograde perfusion was an independent risk factor for stroke (OR = 3.3; P = 0.004). Other risk factors were conversion to sternotomy (OR = 12; P = 0.001), active endocarditis (OR = 5.8; P = 0.07) and hypercholesterolaemia (OR = 2.4; P = 0.048). Interaction modelling revealed that the only significant risk factor for a neurological event was the use of retrograde perfusion in patients older than 70 years with an atherosclerotic burden (OR = 6.4; P = 0.033). Conclusions Minimally invasive mitral valve procedures can be performed with low morbidity and mortality. The use of retrograde perfusion is associated with a higher incidence of neurological complications in older patients with atherosclerotic burden. Central aortic cannulation permits avoidance of complications associated with retrograde perfusion and extends the suitability of minimally invasive mitral procedures to those patients who have an absolute contraindication for femoral artery cannulation.
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Affiliation(s)
- Michele Murzi
- Fondazione Toscana Gabriele Monasterio, G. Pasquinucci Heart Hospital, Massa, Italy
| | - Alfredo G Cerillo
- Fondazione Toscana Gabriele Monasterio, G. Pasquinucci Heart Hospital, Massa, Italy
| | - Tommaso Gasbarri
- Fondazione Toscana Gabriele Monasterio, G. Pasquinucci Heart Hospital, Massa, Italy
| | - Rafik Margaryan
- Section of Cardiac Surgery, Cardiac Thoracic and Vascular Department, University Hospital, Pisa, Italy
| | - Enkel Kallushi
- Fondazione Toscana Gabriele Monasterio, G. Pasquinucci Heart Hospital, Massa, Italy
| | - Pierandrea Farneti
- Fondazione Toscana Gabriele Monasterio, G. Pasquinucci Heart Hospital, Massa, Italy
| | - Marco Solinas
- Fondazione Toscana Gabriele Monasterio, G. Pasquinucci Heart Hospital, Massa, Italy
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Bouhout I, Morgant MC, Bouchard D. Minimally Invasive Heart Valve Surgery. Can J Cardiol 2017; 33:1129-1137. [DOI: 10.1016/j.cjca.2017.05.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 05/22/2017] [Accepted: 05/22/2017] [Indexed: 11/26/2022] Open
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Ramlawi B, Bedeir K, Lamelas J. Aortic Valve Surgery: Minimally Invasive Options. Methodist Debakey Cardiovasc J 2017; 12:27-32. [PMID: 27127559 DOI: 10.14797/mdcj-12-1-27] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Minimally invasive aortic valve surgery has not been adopted by a significant proportion of cardiac surgeons despite proven benefits. This may be related to a high learning curve and technical issues requiring retraining. In this review, we discuss the data for minimally invasive aortic valve surgery and describe our operative technique for both ministernotomy and anterior thoracotomy approaches. We also discuss the advent of novel sutureless valves and how these techniques compare to available transcatheter aortic valve procedures.
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DeCampli WM. Reducing stroke during cardiac surgery: Back flushing and manipulation is for plumbers, not surgeons. J Thorac Cardiovasc Surg 2017; 154:488-489. [PMID: 28442153 DOI: 10.1016/j.jtcvs.2017.03.111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 03/23/2017] [Indexed: 11/28/2022]
Affiliation(s)
- William M DeCampli
- The Heart Center, Arnold Palmer Hospital for Children, Orlando, Fla; Department of Clinical Sciences, University of Central Florida College of Medicine, Orlando, Fla.
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