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Thornton SW, Hoover AC, Nellis JR, Overbey DM, Andersen ND, Haney JC, Turek JW. Minimally Invasive Approach for Cardiac Hemangioma Resection in a Teenager. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2022; 17:358-360. [PMID: 35770608 DOI: 10.1177/15569845221107012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Cardiac hemangiomas are a rare tumor traditionally resected by median sternotomy. We performed a minimally invasive right ventricular cardiac hemangioma resection via a left anterior mini-incision (LAMI). The procedure was without complication, and the patient was discharged on postoperative day 2. The LAMI has been used broadly by our team for operations involving the right ventricular outflow tract, as an alternative to median sternotomy. Here we show that it can also be used for the resection of a cardiac tumor.
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Affiliation(s)
| | | | - Joseph R Nellis
- Department of Surgery, 22957Duke University Hospitals, Durham, NC, USA.,Duke Congenital Heart Surgery Research & Training Laboratory, Durham, NC, USA
| | - Douglas M Overbey
- Duke Congenital Heart Surgery Research & Training Laboratory, Durham, NC, USA.,Division of Cardiothoracic Surgery, 22957Duke University Hospitals, Durham, NC, USA
| | - Nicholas D Andersen
- Duke Congenital Heart Surgery Research & Training Laboratory, Durham, NC, USA.,Division of Cardiothoracic Surgery, 22957Duke University Hospitals, Durham, NC, USA.,Pediatric & Congenital Heart Center, Duke Children's Hospital, Durham, NC, USA
| | - John C Haney
- Division of Cardiothoracic Surgery, 22957Duke University Hospitals, Durham, NC, USA
| | - Joseph W Turek
- Duke Congenital Heart Surgery Research & Training Laboratory, Durham, NC, USA.,Division of Cardiothoracic Surgery, 22957Duke University Hospitals, Durham, NC, USA.,Pediatric & Congenital Heart Center, Duke Children's Hospital, Durham, NC, USA
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Thornton S, Kang L, Nellis J, Andersen ND, Haney J, Turek J. Comparison of median sternotomy and left anterior mini-incision for pulmonary valve replacement following primary tetralogy of Fallot repair. Cardiol Young 2022; 33:1-5. [PMID: 35067250 DOI: 10.1017/s1047951122000105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Pulmonary insufficiency requiring reintervention frequently occurs after primary tetralogy of Fallot repair. Repeat interventions present a challenge for both the surgeon and patient. We compare a minimally invasive, 5 cm left anterior mini-incision to redo median sternotomy for pulmonary valve replacement in tetralogy of Fallot patients. METHODS Following Internal Review Board approval, we conducted a single institution retrospective review of patients with tetralogy of Fallot who underwent pulmonary valve replacement via redo median sternotomy or left anterior mini-incision between 13 July, 2016 and 6 March, 2020. RESULTS Twenty-three patients underwent pulmonary valve replacement following primary tetralogy of Fallot repair between March 2016 and March 2020. Twelve patients received a redo-median sternotomy from March 2016 to August 2018. Left anterior mini-incision was first offered in August of 2018 and was chosen by all eleven patients thereafter. The two groups had similar baseline characteristics including preoperative pulmonary valve dysfunction. Early trends suggest a longer cardiopulmonary bypass time for patients who received left anterior mini-incisions. Other outcomes were comparable, including operative times, blood product requirements, residual pulmonary valve dysfunction, postoperative pain, narcotic requirements, ICU length of stay, total length of stay, and postoperative complications. CONCLUSIONS In patients who have previously undergone primary repairs of tetralogy of Fallot, outcomes for pulmonary valve replacement via left anterior mini-incision are comparable to those via redo median sternotomy.
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Affiliation(s)
- Steven Thornton
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Lillian Kang
- Congenital Heart Surgery Research & Training Laboratory, Duke University Medical Center, Durham, NC, USA
| | - Joseph Nellis
- Congenital Heart Surgery Research & Training Laboratory, Duke University Medical Center, Durham, NC, USA
| | - Nicholas D Andersen
- Congenital Heart Surgery Research & Training Laboratory, Duke University Medical Center, Durham, NC, USA
- Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, NC, USA
| | - John Haney
- Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Joseph Turek
- Congenital Heart Surgery Research & Training Laboratory, Duke University Medical Center, Durham, NC, USA
- Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, NC, USA
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Zhu J, Zhang Y, Bao C, Ding F, Mei J. Individualized strategy of minimally invasive cardiac surgery in congenital cardiac septal defects. J Cardiothorac Surg 2022; 17:5. [PMID: 35033146 PMCID: PMC8761281 DOI: 10.1186/s13019-022-01753-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 01/08/2022] [Indexed: 12/03/2022] Open
Abstract
Background Intracardiac septal defect is repaired using median sternotomy in most centers; however, there are several reports using minimally invasive surgery in both children and adults. This study summarized our strategy of minimally invasive therapy using various lateral mini-thoracotomies in patients with congenital septal defect. Methods In this study, 472 patients who underwent minimally invasive repair of intracardiac septal defects (atrial septal defect, (ASD), ventricular septal defect, (VSD), and atrioventricular septal defect, (AVSD)) from January 2012 to June 2020 were retrospectively reviewed. Those who underwent device closure were excluded. The minimally invasive strategy included three groups: the right sub-axillary vertical incision (RSAVI) group (N = 335, including192 ASDs, 135 VSDs and 8 AVSDs); the right anterolateral thoracotomy (RALT) group (N = 132, including 77 ASDs, 51 VSDs and 4 AVSDs); and the left anterolateral thoracotomy (LALT) group (N = 5, all subpulmonary VSDs). Results Concomitant surgeries included nine cases of right ventricular outflow tract obstruction relief, nine cases of mitral repairs and 37 cases of tricuspid repairs. There was one transition from thoracotomy to sternotomy. Three patients required second pump run for residual lesions (two residual VSD shunts and one mitral regurgitation). The age and body weight of the RSAVI group were significantly lower than those of the RALT and LALT groups (all P < 0.01). No postoperative death was observed. Postoperative complications included one case of chest exploration for bleeding, one case of reoperation due to patch dehiscence during the same admission, one case of transient neural dysfunction, three cases of diaphragmatic paresis and 13 cases of atelectasis. The median stay in the intensive care unit was two days, while the median postoperative hospitalization duration was six days. The echocardiography results before discharge indicated no significant residual lesions. No reoperation, no new onset of chest deformities and no sclerosis were observed during the follow-up. Conclusions Intracardiac septal defects can be safely and effectively repaired by minimally invasive surgery with good cosmetic results. RSAVI is suitable in infants and children, while RALT is more commonly used in adolescents and adults. LALT is an alternative incision to repair subpulmonary VSD.
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Affiliation(s)
- Jiaquan Zhu
- Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Yunjiao Zhang
- Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China.
| | - Chunrong Bao
- Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China.
| | - Fangbao Ding
- Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Ju Mei
- Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
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Nellis JR, Daneshmand MA, Gaca JG, Andersen ND, Haney JC, Turek JW. A single center experience with minimally invasive approaches in congenital cardiac surgery. J Thorac Dis 2021; 13:5818-5825. [PMID: 34795930 PMCID: PMC8575860 DOI: 10.21037/jtd-21-836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 07/14/2021] [Indexed: 11/24/2022]
Abstract
Background Cardiac surgery is a technically demanding field with an appreciable learning curve that extends beyond formal training. Minimally invasive congenital cardiac surgery has one of the steepest learning curves. Early complications often discourage surgeons, particularly those at lower volume centers, from pursuing innovative approaches. Over the past three years, we have utilized a number of minimally invasive approaches including pulmonary valve replacement, anomalous aortic origin coronary artery repair, atrial septal defect repair, epicardial lead placement, and partial anomalous pulmonary venous return. Herein we report on our experience performing minimally invasive congenital cardiac surgery, lessons learned, and how our approach has evolved. Methods We performed a single institution, retrospective review, wherein continuous variables were reported as median (interquartile range). Results Between September 2017 and May 2020, minimally invasive approaches were attempted on 49 patients with a median age of 19 years (14–47 years) for nine distinct congenital cardiac diagnoses. Seven patients (14%) required conversion to larger incisions, including four patients or 36% of those undergoing anomalous aortic origin of a coronary artery repair. Patients who were converted had a higher body mass index 33.1 (31.7–37.8) than those who were not (24.2, 20.8–29.3) (P=0.009). Conclusions Minimally invasive approaches for congenital cardiac conditions require a team approach. Patients with a body mass index greater than 30 should be counseled on the higher rate of conversion. We no longer perform minimally invasive anomalous aortic origin of a coronary artery repair given the high rate of conversions and complications. Surgeons attempting this procedure should do so cautiously.
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Affiliation(s)
- Joseph R Nellis
- Department of Surgery, Duke University, Durham, NC, USA.,Duke Congenital Heart Surgery Research & Training Laboratory, Durham, NC, USA
| | - Mani A Daneshmand
- Department of Surgery, Duke University, Durham, NC, USA.,Division of Thoracic and Cardiovascular Surgery, Duke University, Durham, NC, USA
| | - Jeffrey G Gaca
- Department of Surgery, Duke University, Durham, NC, USA.,Division of Thoracic and Cardiovascular Surgery, Duke University, Durham, NC, USA
| | - Nicholas D Andersen
- Department of Surgery, Duke University, Durham, NC, USA.,Duke Congenital Heart Surgery Research & Training Laboratory, Durham, NC, USA.,Division of Thoracic and Cardiovascular Surgery, Duke University, Durham, NC, USA.,Pediatric & Congenital Heart Center, Duke Children's Hospital, Durham, NC, USA
| | - John C Haney
- Department of Surgery, Duke University, Durham, NC, USA.,Division of Thoracic and Cardiovascular Surgery, Duke University, Durham, NC, USA
| | - Joseph W Turek
- Department of Surgery, Duke University, Durham, NC, USA.,Duke Congenital Heart Surgery Research & Training Laboratory, Durham, NC, USA.,Division of Thoracic and Cardiovascular Surgery, Duke University, Durham, NC, USA.,Pediatric & Congenital Heart Center, Duke Children's Hospital, Durham, NC, USA
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Said SM, Marey G, Hiremath G, Aggarwal V, Kloesel B, Griselli M. Pulmonary valve replacement via left anterior minithoracotomy: Lessons learned and early experience. J Card Surg 2021; 36:1305-1312. [PMID: 33533086 DOI: 10.1111/jocs.15382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/18/2021] [Accepted: 01/20/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Median sternotomy has been the standard for pulmonary valve replacement (PVR) in patients with free pulmonary regurgitation (PR) and right ventricular enlargement. With the introduction of transcatheter therapy, the search for an alternate to sternotomy is mandated. We present our early experience with a limited anterior left thoracotomy approach. METHODS We used a left anterior mini-thoracotomy in six male patients (15 ± 1.94 years of age) who developed progressive right ventricular enlargement due to chronic PR. RESULTS Primary diagnoses were tetralogy of Fallot in five patients and pulmonary atresia with an intact septum in another. Four patients had previous median sternotomy with transannular patch repair. The mean right ventricular end-diastolic volume index was 189 ± 27.13 ml/m2 . The procedure was feasible in all patients. All patients had satisfactory adult size pulmonary bioprosthesis (25 or 27 mm valve), with a mean peak gradient of 18 ± 2.40 mmHg across the prosthesis at discharge. All patients were extubated intraoperatively at the end of the procedure and required no intraoperative transfusions. There were no early or late mortalities. Early morbidities included left hemidiaphragm paralysis in one patient, and re-sternotomy for prosthetic valve endocarditis in one. One patient required late reoperation for a common femoral artery pseudoaneurysm. CONCLUSIONS Minimally invasive access for PVR is feasible in both primary and repeat settings, through a limited anterior left minithoracotomy in the absence of intracardiac shunts and the need for other concomitant cardiac procedures. Longer-term studies with a larger number of patients are needed to compare the efficacy of this approach to standard sternotomy.
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Affiliation(s)
- Sameh M Said
- Division of Pediatric Cardiovascular Surgery, Masonic Children's Hospital, University of Minnesota, Minneapolis, Minnesota, USA.,Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Gamal Marey
- Division of Pediatric Cardiovascular Surgery, Masonic Children's Hospital, University of Minnesota, Minneapolis, Minnesota, USA
| | - Gurumurthy Hiremath
- Divisions of Pediatric Cardiology, Masonic Children's Hospital, University of Minnesota, Minneapolis, Minnesota, USA
| | - Varun Aggarwal
- Divisions of Pediatric Cardiology, Masonic Children's Hospital, University of Minnesota, Minneapolis, Minnesota, USA
| | - Benjamin Kloesel
- Divisions of Pediatric Anestheiology, Masonic Children's Hospital, University of Minnesota, Minneapolis, Minnesota, USA
| | - Massimo Griselli
- Division of Pediatric Cardiovascular Surgery, Masonic Children's Hospital, University of Minnesota, Minneapolis, Minnesota, USA
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Carrel T. Commentary: Pulmonary valve replacement through a small incision is attractive but means limited possibilities for right ventricular outflow tract repair. JTCVS Tech 2020; 6:132-133. [PMID: 34318172 PMCID: PMC8300894 DOI: 10.1016/j.xjtc.2020.12.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 12/27/2020] [Accepted: 12/29/2020] [Indexed: 12/02/2022] Open
Affiliation(s)
- Thierry Carrel
- Department of Cardiovascular Surgery, University Hospital and University of Bern, Bern, Switzerland
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Nellis JR, Turek JW, Andersen ND. Commentary: Minimally invasive pulmonary valve replacement and the adoption curve for novel techniques. JTCVS Tech 2020; 6:130-131. [PMID: 34318171 PMCID: PMC8300893 DOI: 10.1016/j.xjtc.2020.12.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 12/14/2020] [Accepted: 12/21/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Joseph R Nellis
- Duke Congenital Heart Surgery Research & Training Laboratory, Duke University, Durham, NC
| | - Joseph W Turek
- Duke Congenital Heart Surgery Research & Training Laboratory, Duke University, Durham, NC.,Division of Thoracic and Cardiovascular Surgery, Duke University, Durham, NC.,Duke Children's Pediatric & Congenital Heart Center, Duke Children's Hospital, Durham, NC
| | - Nicholas D Andersen
- Duke Congenital Heart Surgery Research & Training Laboratory, Duke University, Durham, NC.,Division of Thoracic and Cardiovascular Surgery, Duke University, Durham, NC.,Duke Children's Pediatric & Congenital Heart Center, Duke Children's Hospital, Durham, NC
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Said SM. Minimally invasive pulmonary valve replacement via left anterior minithoracotomy. JTCVS Tech 2020; 6:127-129. [PMID: 34318170 PMCID: PMC8300920 DOI: 10.1016/j.xjtc.2020.11.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 11/25/2020] [Indexed: 11/25/2022] Open
Affiliation(s)
- Sameh M Said
- Division of Pediatric Cardiovascular Surgery, Masonic Children's Hospital, University of Minnesota, Minneapolis, Minn
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