TITLE:
Hundred plus Minimally Access Cardiac Surgery: Our Experience
AUTHORS:
Anil Bhattarai, Arjun Gurung, Prabhat Khakural, Ravi Baral, Bhagawan Koirala
KEYWORDS:
Minimal Invasive Cardiac Surgery, Cosmetic Outcome, Total Peripheral Cannulation
JOURNAL NAME:
World Journal of Cardiovascular Surgery,
Vol.12 No.10,
October
24,
2022
ABSTRACT: Background: Minimally invasive procedures lead to less scarring resulting in better
cosmetic outcomes. This
has resulted in increased patient interest in such procedures and this has
motivated surgeons to pursue newer and improved techniques for Minimally
invasive cardiac surgery (MICS). Obviously, with the advent of MICS the techniques to achieve
it also needed to be changed and upgraded which includes access for cannulation
for cardiopulmonary bypass (CPB).
Right internal jugular vein percutaneous cannulation, together with the direct surgical cannulation of femoral vessels with
minithoracotomy/ministernotomy proves to be a safe and effective tool in
patients with body weight of above 20 kg for minimally access cardiac surgery.
We use this technique for Atrial septal defect (ASD) closure, aortic valve replacement (AVR), redo
Tricuspid valve replacement (TVR) and mitral valve replacement (MVR). Here, we
describe our experience with minimally invasive approach using total peripheral
cannulation and an
anterior mini-thoracotomy (6 cm or less) incision for ASD closure,
AVR, TVR and MVR. Methods: The preoperative variables, intraoperative
data and postoperative outcomes of patients undergoing minimally invasive ASD
closure, AVR, TVR and MVR with total peripheral cannulation were collected and analyzed. Results: Between
May 2014 to May 2019 we
performed minimally invasive closure of atrial septal defects, AVR, TVR and MVR with
total peripheral cannulation in 103 patients. There were 64 females and 39 males Mean
age was 25 years (range 8 - 58 years), Spectrum of procedures include ASD closure in 81
patients (78.6%), AVR via minithoracotomy in 13 patients (12.6%) and AVR via
ministernotomy in 3 patients (2.9%),
redo TVR in 5 (4.8%), MVR in 1 patient (0.97%). Average cardiopulmonary bypass (CPB) time was 46 minutes (range 22 - 78 min)
and average aortic cross-clamp time (AoX) 26 min (range 12 - 45 min) in
ASD closure group. In AVR
group average CPB time was 91 min (range 72 - 120 min)
and AoX time 76.5 min (range
65 - 109 min). In TVR group average
CPB time 54 min (range 45 - 67 min) on beating heart.
Only one MVR done in this period and CPB time was 82 min and AoX time was 65
min. The mean length of stay in intensive care unit was 1.8 days in ASD
closure, 2 days in
AVR group when in TVR group 3.5 days, and hospital stay was 3 days in ASD
closure group, 4 days in AVR group and 7 days in TVR group. The only one
patient who underwent MVR died in 12th post operative day from
sepsis. There was one late mortality in AVR group after reoperation for
prosthetic valve endocarditis at 3 months from first operation. Conclusion: ASD
closure, AVR, TVR and MVR with mini invasive approach is safe with very few manageable
preoperative complications and good patient satisfaction.