Статті в журналах: "Minimal Invasive Cardiac Surgery"

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Onan, Burak. "Minimal access in cardiac surgery." Turkish Journal of Thoracic and Cardiovascular Surgery 28, no. 4 (October 22, 2020): 708–24. http://dx.doi.org/10.5606/tgkdc.dergisi.2020.19614.

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Over the past two decades, minimally invasive cardiac surgery has been adopted with the use of endoscopic methods in 1990s and advanced robotic surgery since the early 2000s. In parallel with technological developments, surgical experience has increased and several cardiac operations are able to be performed using different mini-incisions. In this review, we discuss approaches to minimally invasive cardiac surgery, incisions, technical details, and suggestions.

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Sampath Kumar, Arkalgud. "What is minimal in “minimally invasive cardiac surgery”?" Asian Cardiovascular and Thoracic Annals 28, no. 6 (June 19, 2020): 339–40. http://dx.doi.org/10.1177/0218492320937140.

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Wadhawa, Vivek A., Kartik G. Patel, Chirag P. Doshi, Jigar K. Shah, Jaydip A. Ramani, Pankaj D. Garg, Sudhir H. Adalti, Yashpal R. Rana, Himani M. Pandya, and Vijay Gupta. "Direct Femoral Cannulation in Minimal Invasive Pediatric Cardiac Surgery." Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 13, no. 4 (July 2018): 300–304. http://dx.doi.org/10.1097/imi.0000000000000540.

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Objective One of the major challenges faced in minimally invasive pediatric cardiac surgery is cannulation strategy for cardiopulmonary bypass. Central aortic cannulation through the same incision has been the usual strategy, but it has the disadvantage of cluttering of the operative field. We hereby present the results of femoral cannulation in minimally invasive pediatric cardiac surgery in terms of adequacy and safety. Methods From January 2013 to June 2016, 200 children (122 males) with mean ± SD age of 9.2 ± 4.51 years (median = 6 years, range = 3–18 years) and weight of 19.22 ± 8.49 kg (median = 15 kg, range = 8–45 kg) were operated for congenital cardiac defects through anterolateral thoracotomy. The most common diagnosis was atrial septal defect (144 patients). In all the patients, femoral artery and femoral vein were cannulated along with direct superior vena cava cannulation for institution of cardiopulmonary bypass. Results There were no deaths or any major complications related to femoral cannulation. Femoral artery cannulation provided adequate arterial inflow, whereas femoral vein with direct superior vena cava cannulation provided adequate venous return in all the patients. No patient required vacuum-assisted venous drainage. No patient required conversion to sternotomy or developed vascular, neurological complications. At discharge and at 1-year follow-up, both femoral artery and vein were patent without a significant stenosis on color Doppler ultrasonography in all the patients. At mean ± SD follow-up period of 30.63 ± 10.09 months, all the patients were doing well without any wound-related, neurological, or vascular complications. Conclusions Femoral arterial and venous cannulation is a feasible, reliable, and efficient method for institution of cardiopulmonary bypass in minimally invasive pediatric cardiac surgery.

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Argiriadou, Helena, Polychronis Antonitsis, Anna Gkiouliava, Evangelia Papapostolou, Apostolos Deliopoulos, and Kyriakos Anastasiadis. "Minimal invasive extracorporeal circulation preserves platelet function after cardiac surgery: a prospective observational study." Perfusion 35, no. 2 (August 5, 2019): 138–44. http://dx.doi.org/10.1177/0267659119866289.

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Introduction: Cardiac surgery on conventional cardiopulmonary bypass induces a combination of thrombocytopenia and platelet dysfunction which is strongly related to postoperative bleeding. Minimal invasive extracorporeal circulation has been shown to preserve coagulation integrity, though effect on platelet function remains unclear. We aimed to prospectively investigate perioperative platelet function in a series of patients undergoing cardiac surgery on minimal invasive extracorporeal circulation using point-of-care testing. Methods: A total of 57 patients undergoing elective cardiac surgery on minimal invasive extracorporeal circulation were prospectively recruited. Anticoagulation strategy was based on individualized heparin management and heparin level–guided protamine titration performed in all patients with a specialized point-of-care device (Hemostasis Management System – HMS Plus; Medtronic, Minneapolis, MN, USA). Platelet function was evaluated with impedance aggregometry using the ROTEM platelet (TEM International GmbH, Munich, Germany). ADPtest and TRAPtest values were assessed before surgery and after cardiopulmonary bypass. Results: ADPtest value was preserved during surgery on minimal invasive extracorporeal circulation (58.2 ± 20 U vs. 53.6 ± 21 U; p = 0.1), while TRAPtest was found significantly increased (90 ± 27 U vs. 103 ± 38 U; p = 0.03). Postoperative ADPtest and TRAPtest values were inversely related to postoperative bleeding (correlation coefficient: −0.29; p = 0.03 for ADPtest and correlation coefficient: −0.28; p = 0.04 for TRAPtest). The preoperative use of P2Y12 inhibitors was identified as the only independent predictor of a low postoperative ADPtest value (OR = 15.3; p = 0.02). Conclusion: Cardiac surgery on minimal invasive extracorporeal circulation is a platelet preservation strategy, which contributes to the beneficial effect of minimal invasive extracorporeal circulation in coagulation integrity.

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Navia, Jose L., Eric E. Roselli, Fernando A. Atik, Gonzalo V. Gonzalez-Stawinski, and Nicholas G. Smedira. "Orthotopic Heart Transplantation through Minimally Invasive Approach." Asian Cardiovascular and Thoracic Annals 15, no. 5 (October 2007): 446–48. http://dx.doi.org/10.1177/021849230701500520.

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Minimal access approaches are a trend in cardiothoracic surgery. Gained experience in these minimally invasive techniques have allowed its application to more complicated procedures, such as heart transplantation. Both classic and bicaval techniques of cardiac transplant were performed through a partial lower sternotomy in 10 end-stage heart failure patients with no previous cardiac surgery. The procedure was considered safe with adequate exposure, minimal postoperative pain medication requirements, acceptable operative times, and good long-term outcome.

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Крачак, Д. И., and В. Д. Крачак. "Experience of Minimal Invasive Extracorporeal Circulation Usage in Cardiac Surgery." Кардиология в Беларуси, no. 6 (January 6, 2022): 966–75. http://dx.doi.org/10.34883/pi.2021.13.6.010.

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Цель. Изучить опыт применения мини-контуров искусственного кровообращения при выполнении кардиохирургических операций и оценить безопасность их использования. Материалы и методы. В исследование было включено 58 пациентов, которым были выполнены различные кардиохирургические вмешательства в условиях искусственного кровообращения (ИК). Из них 14 пациентов были прооперированы с использованием мини-контуров ИК (группа MiECC), а у 44 пациентов были использованы стандартные «открытые» контуры ИК (группа CECC). Виды проведенных операций: АКШ - 46,6%, АКШ и клапанная коррекция - 13,8%, клапанная коррекция - 25,9%, протезирование восходящей аорты - 8,6%, прочие операции - 5,2%. Длительность ИК и ишемии миокарда в исследуемых группах не различалась (р=0,696 и р=0,501 соответственно). Результаты. Скорость перфузии для группы MiECC составила 4,1 (3,9-4,4) л/мин, для группы CECC - 4,5 (4,0-4,95) л/мин (р=0,021). В обеих группах сатурация тканей головного мозга статистически значимо не различалась. Интраоперационные уровни лактата были в группе MiECC 1,4 (1,2-1,9) ммоль/л, в группе CECC - 2,2 (1,6-3,0) ммоль/л (р=0,003). Частота использования препаратов крови в группе CECC составила 20,5%. Заключение. Использование мини-контуров для искусственного кровообращения является безопасным для пациента. Применение данной технологии позволяет минимизировать использование донорских компонентов крови и, соответственно, снизить частоту трансфузий зависимых осложнений. Purpose. To study the experience of minimal invasive extracorporeal circulation usage during cardiac surgery and to assess the safety of their use. Materials and methods. The study included 58 patients who underwent various types of cardiac surgery under cardiopulmonary bypass. 14 patients were operated using minimal invasive extracorporeal circuit (MiECC group) and 44 patients had standard conventional extracorporeal circuit (CECC group). Types of operations performed were CABG 46.6%, CABG combined with valve procedure 13.8%, isolate valve correction 25.9%, prosthetics of the ascending aorta 8.6%, other operations 5.2%. Bypass and aortic cross clamp times in studying groups did not differ (p=0.696 and p=0.501, respectively). Results. The perfusion rate for the MiECC group was 4.1 (3.9-4.4) l/min, for the CECC group - 4.5 (4.0- 4.95) l/min (p=0.021). In both groups the saturation of brain tissues (NIRS) did not differ significantly. Intraoperative lactate levels in the MiECC group were 1.4 (1.2-1.9) mmol/L, in the CECC group 2.2 (1.6- 3.0) mmol/L (p=0.003). The frequency of blood products usage in the CECC group was 20.5%. Conclusion. Minimal invasive extracorporeal circulation usage is safe procedure for the patient. This technology allows to minimize usage of donor blood components and reduces the frequency of transfusion-associated complications.

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Vandoren, Vincent, Thomas Phlips, and Philippe Timmermans. "Bundle Branch Re-Entrant Ventricular Tachycardia after Minimal Invasive Cardiac Surgery." Hearts 2, no. 4 (December 15, 2021): 570–74. http://dx.doi.org/10.3390/hearts2040044.

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Background: Bundle branch re-entrant ventricular tachycardia (BBRVT) is a monomorphic ventricular arrhythmia with wide QRS complexes caused by re-entrant tachycardia between both bundle branches. BBRVT can occur in a variety of cardiac pathologies with His–Purkinje system (HPS) conduction abnormalities such as dilated cardiomyopathy, coronary artery disease, hypertrophic cardiomyopathy, valvular heart disease and even after aortic valve surgery. Case report: A 62-year-old male patient with an ischemic cardiomyopathy and implantable cardioverter defibrillator (ICD) underwent minimal invasive aortic valve replacement (Yil-AVR) and coronary artery bypass graft (CABG). He was remitted a week later because of relapsing sustained ventricular tachycardia (VT). Electrocardiogram showed a wide QRS tachycardia, which was remarkably similar to the patient’s sinus rhythm. Analysis of ICD revealed the presence of BBRVT. Catheter ablation of the right bundle branch (RBB) was performed. He is currently in clinical follow-up and no reoccurrence of VT has been recorded so far. Conclusion: Patients with known cardiomyopathy can develop BBRVT early after cardiac surgery. To our knowledge, this is the first time that BBRVT occurred after Yil-AVR.

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Ellam, Sten, Otto Pitkänen, Pasi Lahtinen, Tadeusz Musialowicz, Mikko Hippeläinen, Juha Hartikainen, and Jari Halonen. "Impact of minimal invasive extracorporeal circulation on the need of red blood cell transfusion." Perfusion 34, no. 7 (April 26, 2019): 605–12. http://dx.doi.org/10.1177/0267659119842811.

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Objective: Minimal invasive extracorporeal circulation may decrease the need of packed red blood cell transfusions and reduce hemodilution during cardiopulmonary bypass. However, more data are needed on the effects of minimal invasive extracorporeal circulation in more complex cardiac procedures. We compared minimal invasive extracorporeal circulation and conventional extracorporeal circulation methods of cardiopulmonary bypass. Methods: A total of 424 patients in the minimal invasive extracorporeal circulation group and 844 patients in the conventional extracorporeal circulation group undergoing coronary artery bypass grafting and more complex cardiac surgery were evaluated. Age, sex, type of surgery, and duration of perfusion were used as matching criteria. Hemoglobin <80 g/L was used as red blood cell transfusion trigger. The primary endpoint was the use of red blood cells during the day of operation and the five postoperative days. Secondary endpoints were hemodilution (hemoglobin drop after the onset of perfusion) and postoperative bleeding from the chest tubes during the first 12 hours after the operation. Results: Red blood cell transfusions were needed less often in the minimal invasive extracorporeal circulation group compared to the conventional extracorporeal circulation group (26.4% vs. 33.4%, p = 0.011, odds ratio 0.72, 95% confidence interval 0.55-0.93), especially in coronary artery bypass grafting subgroup (21.3% vs. 35.1%, p < 0.001, odds ratio 0.50, 95% confidence interval 0.35-0.73). Hemoglobin drop after onset of perfusion was also lower in the minimal invasive extracorporeal circulation group than in the conventional extracorporeal circulation group (24.2 ± 8.5% vs. 32.6 ± 12.6%, p < 0.001). Postoperative bleeding from the chest tube did not differ between the groups (p = 0.808). Conclusion: Minimal invasive extracorporeal circulation reduced the need of red blood cell transfusions and hemoglobin drop when compared to the conventional extracorporeal circulation group. This may have implications when choosing the perfusion method in cardiac surgery.

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Nijs, Kristof, Jeroen Vandenbrande, Fidel Vaqueriza, Jean-Paul Ory, Alaaddin Yilmaz, Pascal Starinieri, Jasperina Dubois, Luc Jamaer, Ingrid Arijs, and Björn Stessel. "Neurological outcome after minimal invasive coronary artery surgery (NOMICS): protocol for an observational prospective cohort study." BMJ Open 7, no. 10 (October 2017): e017823. http://dx.doi.org/10.1136/bmjopen-2017-017823.

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IntroductionAdverse neurocognitive outcomes are still an important cause of morbidity and mortality after cardiac surgery. The most common neurocognitive disorders after conventional cardiac surgery are postoperative cognitive dysfunction (POCD), stroke and delirium. Minimal invasive cardiac procedures have recently been introduced into practice. Endoscopic coronary artery bypass grafting (Endo-CABG) is a minimal invasive cardiac procedure based on the conventional CABG procedure. Neurocognitive outcome after minimal invasive cardiac surgery, including Endo-CABG, has never been studied. Therefore, the main objective of this study is to examine neurocognitive outcome after Endo-CABG.Methods and analysisWe will perform a prospective observational cohort study including 150 patients. Patients are categorised into three groups: (1) patients undergoing Endo-CABG, (2) patients undergoing a percutaneous coronary intervention and (3) a healthy volunteer group. All patients in the Endo-CABG group will be treated following a uniform, standardised protocol. To assess neurocognitive outcome after surgery, a battery of six neurocognitive tests will be administered at baseline and at 3-month follow-up. In the Endo-CABG group, a neurological examination will be performed at baseline and postoperatively and delirium will be scored at the intensive care unit. Quality of life (QOL), anxiety and depression will be assessed at baseline and at 3-month follow-up. Satisfaction with Endo-CABG will be assessed at 3-month follow-up. Primary endpoints are the incidence of POCD, stroke and delirium after Endo-CABG. Secondary endpoints are QOL after Endo-CABG, patient satisfaction with Endo-CABG and the incidence of anxiety and depression after Endo-CABG.Ethics and disseminationThe neurological outcome after minimal invasive coronary artery surgery study has received approval of the Jessa Hospital ethics board. It is estimated that the trial will be executed from December 2016 to January 2018, including enrolment and follow-up. Analysis of data, followed by publication of the results, is expected in 2018.Trial registration numberNCT02979782.

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Şimşek, Mustafa, and Türkan Kudsioğlu. "Our Experiences in Percutaneous Cannulation and Monitoring in Minimal Invasive Cardiac Surgery." Hamidiye Medical Journal 3, no. 3 (December 1, 2022): 171–76. http://dx.doi.org/10.4274/hamidiyemedj.galenos.2022.72473.

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El-Essawi, Aschraf, Mohammed Morjan, Ingo Breitenbach, Ahmed Bechri, Rene Brouwer, and Wolfgang Harringer. "Modular minimal invasive extracorporeal circuits: another step toward universal applicability?" Perfusion 32, no. 7 (June 3, 2017): 598–605. http://dx.doi.org/10.1177/0267659117712404.

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Introduction: Safety concerns have been one of the main reasons opposing a wider acceptance of minimal invasive extracorporeal circuits (MiECC). Following an extensive experience and a multitude of modifications, we have set out to employ a modular MiECC as a universal extracorporeal circuit. Methods: A total of 129 cardiac surgical procedures were performed by a single surgeon in 2013. Excluding procedures done under circulatory arrest or with the potential need of such, the MiECC was utilized in almost 90% of surgeries. Of sixty-two (simple procedures) patients who underwent coronary artery bypass grafting (CABG), aortic valve replacement (AVR) or CABG + AVR, 82% were non-elective, 10% had a left ventricular ejection fraction (EF) <30% and most had an impaired renal function. Thirty-eight patients had more complex surgeries (complex procedures), 37% of which were urgent, 15% had an EF <30% and the majority had renal dysfunction. Results: The 30-day mortality was 5% in simple procedures and 2.5% in complex procedures. The incidence of postoperative atrial fibrillation was 13% and 16%, respectively. Optimum outcome was defined as a freedom from all complications and blood transfusions and was achieved in 52% and 42%, respectively. Conclusions: This report shows that modular MiECC can be employed with a high safety margin in cardiac surgery. Furthermore, it emphasizes the impact that minimal invasive philosophy could have in improving patient care.

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Alvarado-Ramos, S., V. J. Lara-Díaz, M. R. López-Gutiérrez, M. E. Torcida-González, and J. F. Campos-Rodríguez. "Minimally Invasive Hemodynamic Assessment during Obstetric Hysterectomy for Invasive Placentation with Epidural Anesthesia." Anesthesiology Research and Practice 2020 (October 28, 2020): 1–12. http://dx.doi.org/10.1155/2020/1968354.

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Background. The present study aimed to describe the evolution of hemodynamic parameters over time of patients with invasive placentation during their third trimester who were delivered via cesarean section and subsequently underwent obstetric hysterectomy under epidural anesthesia. Methods. A prospective, descriptive, longitudinal, 11-month cohort study of 43 patients aged between 18 and 37 years who presented with invasive placentation. Minimal invasive monitoring was placed before the administration of epidural anesthesia for hemodynamic parameter tracking during the cesarean section. After delivery, the patients underwent an obstetric hysterectomy. Blood loss, hemodynamic parameters, and coagulation were managed via goal-directed therapy. Parameters were compared via repeated measures ANOVA and effect size estimation (Cohen’s d). Results. The mean age of the patients was 29.2 ± 3.4 years and was moderately overweight. They had minor cardiac index variance ( P = NS , no significance), vascular systemic resistance index (NS), heart rate ( P = NS ), and median arterial pressure ( P = NS ). Differences were observed in the stroke volume index ( P = 0.015 ) due to moderately higher values (d = 0.3, P = 0.016 ) in the middle of the surgery. Patients had lower cardiac index (d = −0.36, NS) and cardiac workload requirements (d = −0.29, P = 0.034 ) toward the completion of surgery. Conclusion. Patients who are in their third trimester and who subsequently underwent obstetric hysterectomy under epidural anesthesia had modest surgical hemodynamic variance and reduced cardiac workload requirements toward the end of the surgery.

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Easterwood, Rachel M., Ian C. Bostock, Shruthi Nammalwar, Jock N. McCullough, and Alexander Iribarne. "The evolution of minimally invasive cardiac surgery: from minimal access to transcatheter approaches." Future Cardiology 14, no. 1 (January 2018): 75–87. http://dx.doi.org/10.2217/fca-2017-0048.

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Baikoussis, NikolaosG, Maria Maimari, Stelios Gaitanakis, Anna Dalipi-Triantafillou, Andreas Katsaros, Charilaos Kantsos, Vasileios Lozos, and Konstantinos Triantafillou. "Does minimal invasive cardiac surgery reduce the incidence of post-operative atrial fibrillation?" Annals of Cardiac Anaesthesia 23, no. 1 (2020): 7. http://dx.doi.org/10.4103/aca.aca_158_18.

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Ruttkay, Tamas, Julia Götte, Ulrike Walle, and Nicolas Doll. "Minimally Invasive Cardiac Surgery Using a 3D High-Definition Endoscopic System." Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 10, no. 6 (November 2015): 431–34. http://dx.doi.org/10.1097/imi.0000000000000216.

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We describe a minimally invasive heart surgery application of the EinsteinVision 2.0 3D high-definition endoscopic system (Aesculap AG, Tuttlingen, Germany) in an 81-year-old man with severe tricuspid valve insufficiency. Fourteen years ago, he underwent a Ross procedure followed by a DDD pacemaker implantation 4 years later for tachy-brady-syndrome. His biventricular function was normal. We recommended minimally invasive tricuspid valve repair. The application of the aformentioned endoscopic system was simple, and the impressive 3D depth view offered an easy and precise manipulation through a minimal thoracotomy incision, avoiding the need for a rib spreading retractor.

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FURUICHI, Yuko, Jun SHIMIZU, Minoru TABATA, Shuichiro TAKANASHI, and Atsuhiro SAKAMOTO. "Anesthetic Management for Minimally Invasive Cardiac Surgery." JOURNAL OF JAPAN SOCIETY FOR CLINICAL ANESTHESIA 32, no. 3 (2012): 402–7. http://dx.doi.org/10.2199/jjsca.32.402.

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Ainsworth, Alan, Michael Larsen, and Claus Fristrup. "PS01.216: INTRODUCING MINIMAL INVASIVE OESOPHAGECTOMY AT A DEPARTMENT." Diseases of the Esophagus 31, Supplement_1 (September 1, 2018): 111. http://dx.doi.org/10.1093/dote/doy089.ps01.216.

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Abstract Background Minimal invasive oesophagectomy has gained increasing popularity. This study reports the results of the first two years after introducing the technique at our department. Methods All procedures have been prospectively registered in a database. All patients were followed until death, 2 years after surgery, or end of the inclusion period. Results 140 procedures were performed (23 November 2015 to 1 February 2018). There were 19 women and 121 men. Median age was 67 years (range 16–83 years). Pathologic T-and N-stage is shown in table 1. Patients were divided into the first 70 patients and the last 70 patients. The mean procedure time was 352 minutes for the ‘first patients’ and 331 minutes for the ‘last patients’ (P < 0.001). The risk for conversion to open surgery in the abdominal procedure was 6% for the ‘first patients’ and 9% for the ‘last patients’ (NS). For the thoracic procedure the corresponding figures were 11% and 6% (NS), respectively. Median length of postoperative stay was 9 days for both groups. The risk of anastomotic leakage was 16% (‘first patients’) and 11% (‘last patients’) (NS). However, in only 4% and 7%, respectively, endoscopic or surgical treatment was required. For all 140 patients, pulmonary complications were observed in 26 cases (18%) and cardiac complications were registered in 15 cases (11%).The 30 day mortality rate was 3% (131 patients) and the 1 year survival rate was 83% (53 patients). Table 1: Pathologic T-and N-stage Conclusion Minimal invasive oesophagectomy can be introduced at a department with acceptable short time morbidity. Disclosure All authors have declared no conflicts of interest.

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Khan, Dibyendu, Saikat Sengupta, Sushan Mukhopadhyay, and Gautam Pati. "Rare case of tracheal bronchus in a patient posted for minimal invasive cardiac surgery." Annals of Cardiac Anaesthesia 23, no. 3 (2020): 364. http://dx.doi.org/10.4103/aca.aca_215_18.

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Baikoussis, Nikolaos G., Nikolaos A. Papakonstantinou, and Efstratios Apostolakis. "The “benefits” of the mini-extracorporeal circulation in the minimal invasive cardiac surgery era." Journal of Cardiology 63, no. 6 (June 2014): 391–96. http://dx.doi.org/10.1016/j.jjcc.2013.12.014.

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Pan, Jun, Qing-Guo Li, Qing Zhou, Jie Zhang, Qiang Wang, Zhong Wu, and Dong-Jin Wang. "Aortopulmonary Window with Subaortic Fibrous Stenosis and Septal Defect: Surgery through a Minimal Right Vertical Infra-Axillary Thoracotomy." Heart Surgery Forum 14, no. 4 (August 22, 2011): 264. http://dx.doi.org/10.1532/hsf98.20111002.

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Aortopulmonary window with subaortic stenosis and ventricular septal defect is an uncommon congenital cardiac malformation that is repaired using cardiopulmonary bypass. The authors describe a 3-year-old patient on whom we performed surgery through a minimal right vertical infra-axillary thoracotomy. This minimally invasive surgery is likely to be applicable in a few cases.

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Phan, T. D., R. Kluger, C. Wan, D. Wong, and A. Padayachee. "A Comparison of Three Minimally Invasive Cardiac Output Devices with Thermodilution in Elective Cardiac Surgery." Anaesthesia and Intensive Care 39, no. 6 (November 2011): 1014–21. http://dx.doi.org/10.1177/0310057x1103900606.

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This study compared the cardiac output responses to haemodynamic interventions as measured by three minimally invasive monitors (Oesophageal Doppler Monitor, the VigileoFlotrac and the LiDCOrapid) to the responses measured concurrently using thermodilution, in cardiac surgical patients. The study also assessed the precision and bias of these monitors in relation to thermodilution measurements. After a fluid bolus of at least 250 ml, the measured change in cardiac output was different among the devices, showing an increase with thermodilution in 82% of measurements, Oesophageal Doppler Monitor 68%, VigileoFlotrac 57% and LiDCOrapid 41%. When comparing the test devices to thermodilution, the kappa statistic showed at best only fair agreement, Oesophageal Doppler Monitor 0.34, LiDCOrapid 0.28 and VigileoFlotrac -0.03. After vasopressor administration, there was also significant variation in the change in cardiac output measured by the devices. Using Bland-Altman analysis, the precision of the devices in comparison to thermodilution showed minimal bias, but wide limits of agreement with percentage errors of Oesophageal Doppler Monitor 64.5%, VigileoFlotrac 47.6% and LiDCOrapid 54.2%. These findings indicate that these three devices differ in their responses, do not always provide the same information as thermodilution and should not be used interchangeably to track cardiac output changes.

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Cheung, Anson, Jia-Lin Soon, Jamil Bashir, Annemarie Kaan, and Andrew Ignaszewski. "Minimal-Access Left Ventricular Assist Device Implantation." Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 9, no. 4 (July 2014): 281–85. http://dx.doi.org/10.1097/imi.0000000000000086.

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Objective The left ventricular assist device (LVAD) is typically implanted through a full sternotomy on cardiopulmonary bypass (CPB). Minimally invasive surgery (MIS) modifications include multiple smaller incisions, using “virgin” territory, and minimized CPB time. Methods Forty-two LVAD implantations were retrospectively reviewed. Twenty-five minimally invasive implantations (MIS, 20 HeartMate II and 5 HeartWare) were compared with 17 sternotomy implantations (12 HeartMate II and 5 HeartWare). The choice of MIS incisions was device dependent: (1) three separate incisions for the HeartMate II or (2) two incisions for the HeartWare device. Four HeartWare LVADs were implanted off-pump (three using the MIS approach). Results The median patient age was 52 years (range, 18–69 years). Overall survival was 81% at a mean (SD) follow-up of 495 (375) days. Thirty-day mortality was 9.5% (one MIS and three sternotomy patients). Five patients (11.9%) died while on LVAD, 18 (42.9%) underwent transplantation, 6 (14.3%) underwent weaning and explantation, and 13 (31.0%) remained on support. Preoperative ventilatory and circulatory supports were more common in the sternotomy group. The MIS patients had shorter CPB time [51.4 (34.9) vs 83.6 (40.4) minutes, P = 0.014] and showed a trend toward lower red blood cell and platelet transfusion requirement. The durations of hospitalization, inotropic support, intensive care unit stay, and LVAD support were not significantly different. Conclusions Minimally invasive surgery LVAD implantation is feasible. The shorter CPB duration and off-pump approach may be advantageous. Avoiding sternotomy may also reduce adhesions encountered during subsequent cardiac transplantation.

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Nawrat, Zbigniew, Zbigniew Malota, Pawel Kostka, and Zbigniew Religa. "The preplanning and advisory system for Robin heart-polish telemanipulator for cardiac minimal invasive surgery." IFAC Proceedings Volumes 36, no. 15 (August 2003): 487–89. http://dx.doi.org/10.1016/s1474-6670(17)33551-6.

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Mubarak, Yasser, Madi nah, and King Salman. "Minimal Invasive Cardiac Surgery for Aortic Valve Replacement Through an Upper Mini-Sternotomy: Multicenter Experience." BOHR International Journal of Research on Cardiology and Cardiovascular Diseases 1, no. 1 (2022): 28–30. http://dx.doi.org/10.54646/bijrccd.004.

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Background: Aortic valve replacement (AVR) by minimally invasive cardiac surgery (MICS) performed through an upper mini-sternotomy has reduced pain after surgery, the risk of bleeding, and the length of hospital stay. Patients and Methods: From January 2019 until December 2022, 230 patients underwent AVR through a partial upper sternotomy (J or inverted-L). The study assessed our early experience with AVR via mini-sternotomy, including cannulation, the progression of the learning curve and patient selection, and ﬁnally morbidity and mortality. Results: Early mortality was 1% (2 patients), and morbidities were 4% (4 patients). The average age was 58 ± 9.7. The mean Euro-SCORE was 4.7%±3.2 and the ejection fraction (EF) was 40%±4.3. The cannulation was performed peripherally in the femoral artery and vein by the direct or percutaneous approach; however, three cases required central cannulation. The average aortic cross clamping time (ACC) for MICS-AVR patients was 83±17 minutes, and the cardiopulmonary bypass (CPB) time was 114±34 minutes. The mean duration of mechanical ventilation (MV) was 4.3±2.5 hours, the average stay in an intensive care unit (ICU) was 1.4±1.2 days, and the mean hospital stay was 4.3 ± 1.3 days. 30-day mortality was 2 patients (1%). The incidence of blood loss and reopenings for bleeding decreased. Conclusions: An upper mini-sternotomy can be used safely to replace an aortic valve, and the minimally invasive approach was not associated with increased morbidity or mortality.

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Sinno, Mohamad. "Micra Transcatheter Pacing System Implant under Direct Visualization During Minimally Invasive Tricuspid Valve Surgery." Clinical Cardiology and Cardiovascular Interventions 3, no. 11 (November 20, 2020): 01–04. http://dx.doi.org/10.31579/2641-0419/105.

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Atrioventricular nodal conduction abnormalities are common after open heart surgery and more so during or after valve surgery. The incidence of atrioventricular (AV) block after tricuspid valve (TV) surgery is higher than what is observed following coronary artery bypass surgery or left sided valve interventions due to the proximity of the TV annulus to the AV node and hence requirements for cardiac pacing are high. However, the mechanical interference between pacing leads and TV leaflet mobility and coaptation can result in regurgitation rendering such an approach counterintuitive. We report a case of Micra Transcatheter pacing system (TPS) implant under direct visualization at the time of tricuspid valve surgery performed via a right mini-thoracotomy approach.

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Hsi, Charles, Henri Cuenoud, Babs R. Soller, Hun Kim, Janice Favreau, Thomas J. Vander Salm, and John M. Moran. "Experimental Coronary Artery Occlusion: Relevance to Off-Pump Cardiac Surgery." Asian Cardiovascular and Thoracic Annals 10, no. 4 (December 2002): 293–97. http://dx.doi.org/10.1177/021849230201000402.

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Mechanical coronary artery occlusion is required for minimally invasive direct coronary artery bypass and off-pump coronary artery bypass surgery. It is important that the method of occlusion be minimally traumatic. Chronic effects of these methods have never been studied. Temporary occlusion of coronaries utilizing suture snare, silastic loop snare, and bulldog clamp was carried out in 12 Yucatan pigs. Three animals each were sacrificed acutely and at 3, 6, and 12 months. The area of occlusion of each vessel was examined by light microscopy and the degree of damage recorded. In the animals sacrificed acutely, there was more damage using the suture snare than with the other 2 methods, but there was minimal damage at longer intervals. There was slight damage acutely and chronically with the bulldog technique. No damage was seen acutely with the silastic loop technique, but some late damage was found. The techniques of coronary artery dissection and occlusion used for minimally invasive and off-pump bypass surgery may contribute to early postoperative graft occlusion.

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Luo, Shuhua, Menglin Tang, Lei Du, Lina Gong, Jin Xu, Youwen Chen, Yabo Wang, Ke Lin, and Qi An. "A Novel Minimal Invasive Mouse Model of Extracorporeal Circulation." Mediators of Inflammation 2015 (2015): 1–9. http://dx.doi.org/10.1155/2015/412319.

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Extracorporeal circulation (ECC) is necessary for conventional cardiac surgery and life support, but it often triggers systemic inflammation that can significantly damage tissue. Studies of ECC have been limited to large animals because of the complexity of the surgical procedures involved, which has hampered detailed understanding of ECC-induced injury. Here we describe a minimally invasive mouse model of ECC that may allow more extensive mechanistic studies. The right carotid artery and external jugular vein of anesthetized adult male C57BL/6 mice were cannulated to allow blood flow through a 1/32-inch external tube. All animals(n=20)survived 30 min ECC and subsequent 60 min observation. Blood analysis after ECC showed significant increases in levels of tumor necrosis factorα, interleukin-6, and neutrophil elastase in plasma, lung, and renal tissues, as well as increases in plasma creatinine and cystatin C and decreases in the oxygenation index. Histopathology showed that ECC induced the expected lung inflammation, which included alveolar congestion, hemorrhage, neutrophil infiltration, and alveolar wall thickening; in renal tissue, ECC induced intracytoplasmic vacuolization, acute tubular necrosis, and epithelial swelling. Our results suggest that this novel, minimally invasive mouse model can recapitulate many of the clinical features of ECC-induced systemic inflammatory response and organ injury.

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Ferrari, Enrico, Ludwig K. von Segesser, Denis Berdajs, Ludwig Müller, Maximilian Halbe, and Francesco Maisano. "Clinical Experience in Minimally Invasive Cardiac Surgery with Virtually Wall-Less Venous Cannulas." Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 13, no. 2 (March 2018): 104–7. http://dx.doi.org/10.1097/imi.0000000000000478.

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Objective Inadequate peripheral venous drainage during minimally invasive cardiac surgery (MICS) is a challenge and cannot always be solved with increased vacuum or increased centrifugal pump speed. The present study was designed to assess the benefit of virtually wall-less transfemoral venous cannulas during MICS. Methods Transfemoral venous cannulation with virtually wall-less cannulas (3/8″ 24F 530–630-mm ST) was performed in 10 consecutive patients (59 ± 10 years, 8 males, 2 females) undergoing MICS for mitral (6), aortic (3), and other (4) procedures (combinations possible). Before transfemoral insertion of wall-less cannulas, a guidewire was positioned in the superior vena cava under echocardiographic control. The wall-less cannula was then fed over the wire and connected to a minimal extracorporeal system. Vacuum assist was used to reach a target flow of 2.4 l/min per m2 with augmented venous drainage at less than −80 mm Hg. Results Wall-less venous cannulas measuring either 630 mm (n = 8) in length or 530 mm (n = 2) were successfully implanted in all patients. For a body size of 173 ± 11 cm and a body weight of 78 ± 26 kg, the calculated body surface area was 1.94 ± 0.32 m2. As a result, the estimated target flow was 4.66 ± 0.78 l/min, whereas the achieved flow accounted for 4.98 ± 0.69 l/min (107% of target) at a vacuum level of 21.3 ± 16.4 mm Hg. Excellent exposure and “dry” intracardiac surgical field resulted. Conclusions The performance of virtually wall-less venous cannulas designed for augmented peripheral venous drainage was tested in MICS and provided excellent flows at minimal vacuum levels, confirming an increased performance over traditional thin wall cannulas. Superior results can be expected for routine use.

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Altae, Jabbar J. "Minimal sternotomy surgery in comparison to standard sternotomy in the coronary bypass Surgery." AL-Kindy College Medical Journal 15, no. 1 (September 12, 2019): 75–78. http://dx.doi.org/10.47723/kcmj.v15i1.85.

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Background Median sternotomy is the gold standard incision for most cardiac operations. However, with the advent of minimal invasive surgery, a new approach emerged in cardiac surgery named mini-sternotomy and has been successfully used to perform a variety of operations. The aim of this paper is to present our experience of using mini-sternotomy to harvest the left internal mammary artery (LIMA) for off-pump revascularization of the left anterior descending artery (LAD) Methodology Over a 2-year period (October 2012-October 2014), 100 patients underwent coronary artery bypass grafting (CABG) via conventional median sternotomy (CMS) (n=80) and mini-sternotomy (MS) (n=20). The 2 groups were compared regarding length and difficulty of surgery, postoperative pain and respiratory function, stay in the intensive care unit (ICU), wound infection, shoulder stability and other variables. Results One patient (5%) with LMS was converted into CMS due to inadequate exposure. The blood loss was less in LMS patients. Lung atelectasis and pleural effusions were less in group 2. A higher PaO2, lower PaCO2 and a shorter assisted-ventilation time were observed in LMS group. Early postoperative pain score & analgesic requirements were less in LMS patients and their hospital stay was shorter (4-5 days) than CMS. Moreover, LMS patients could return to their jobs and drove cars earlier than group 2 patients. There were 9 deaths (11.3%) in CMS group vs. one death (5%) in LMS group; however, this difference was not statistically significant (p˂0.05) Conclusions This study shows that off-pump coronary surgery through mini-sternotomy incision is feasible and safe.

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OZAWA, Hidechika, Shinsuke HAMAGUCHI, Kohei NEMOTO, Taro OTANI, Naoki FURUKAWA, and Shigeki YAMAGUCHI. "A Report of Three Cases of Right Unilateral Pulmonary Edema after Minimally Invasive Cardiac Surgery for Mitral Regurgitation." JOURNAL OF JAPAN SOCIETY FOR CLINICAL ANESTHESIA 35, no. 2 (2015): 166–71. http://dx.doi.org/10.2199/jjsca.35.166.

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Dueñas, Giovanny. "Analysis of the Costs and Clinical Outcomes of a Minimally Invasive Cardiac Surgery Program in a Colombian Teaching Hospital." Journal of Thoracic Disease and Cardiothoracic Surgery 1, no. 2 (July 15, 2020): 01–05. http://dx.doi.org/10.31579/2693-2156/008.

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Rokonujjaman, Mohammad, Naveen SK, Shaheedul Islam, Nusrat Ghafoor, Syed Tanvir Ahmad, Abdullah Al Shoeb, Atiqur Rahman, et al. "Experience of Minimal Invasive Cardiac Surgery for repair of Atrial Septal Defects- A Single Center Study." Cardiovascular Journal 14, no. 1 (September 15, 2021): 37–43. http://dx.doi.org/10.3329/cardio.v14i1.55372.

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Background: Atrial Septal Defects (ASD) can be closed surgically using conventional midline sternotomy or minimal invasive technique. This study was done to evaluate the outcome and safety of the minimal invasive cardiac surgical (MICS) approach using right vertical infra axillary incision (RVAI) for the repair of ASD. Methods: We performed a prospective observational cross-sectional analysis on 50 patients who were diagnosed as ASD of various types and not amenable to device closure. Their surgery was done RVAI using central cardiopulmonary bypass. Outcome of the study was evaluated using the following variables: length of the incision, satisfaction of patients, mortality, infection of surgical site, blood transfusion, duration of total operation, intensive care unit (ICU) stay, mechanical ventilation, hospital stay and aortic occlusion. Operations were done between December 2013 to December 2020. All the recruited patients were treated through RVAI as per patient’s choice. Results: Mean age was 11.4± 6.4 years. 18(36%) were male and 32(64%) were female. Body weight ranged from 10 to 65 kg. Mean length of incision was 6.2±0.8 cm. Mean aortic occlusion time was 42±14 min. ASD closed directly, using autologous treated pericardial patch or dacron patch. Mean total operation time was 4.08±0.6 hours and mean mechanical ventilation time was 8.3±5 hours. Average ICU stay was 35.6±6 hours and total hospital stay was 7.2±0.9 days. There was no significant blood loss. Only 10 patients required intravenous (IV) analgesics in the post-operative period. One patient required re-exploration, one conversion to median sternotomy and one suffered from superficial skin infection. There were no operative or late mortalities. Patient satisfaction was excellent. Conclusions: MICS technique using RVAI for surgical repair of ASD revealed a safe procedure and could be performed with excellent cosmetic and clinical outcomes. It provided a good alternative to the standard median sternotomy. Cardiovasc j 2021; 14(1): 37-43

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Kim, Seokkon, Jaegyok Song, Sungmi Ji, Min A. Kwon, and Dajeong Nam. "Efficacy of minimal invasive cardiac output and ScVO2 monitoring during controlled hypotension for double-jaw surgery." Journal of Dental Anesthesia and Pain Medicine 19, no. 6 (2019): 353. http://dx.doi.org/10.17245/jdapm.2019.19.6.353.

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Anastasiadis, Kyriakos, John Murkin, Polychronis Antonitsis, Adrian Bauer, Marco Ranucci, Erich Gygax, Jan Schaarschmidt, et al. "Use of minimal invasive extracorporeal circulation in cardiac surgery: principles, definitions and potential benefits. A position paper from the Minimal invasive Extra-Corporeal Technologies international Society (MiECTiS)." Interactive CardioVascular and Thoracic Surgery 22, no. 5 (January 26, 2016): 647–62. http://dx.doi.org/10.1093/icvts/ivv380.

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Elhassan, Hind, Abdelrahman Abdelbar, Rebecca Taylor, Grzegorz Laskawski, Palanikumar Saravanan, Andrew Knowles, and Joseph Zacharias. "A Propensity Score Analysis of Early and Long-Term Outcomes of Retrograde Arterial Perfusion for Endoscopic and Minimally Invasive Heart Valve Surgery in Both Young and Elderly Patients." Journal of Cardiovascular Development and Disease 9, no. 2 (January 28, 2022): 44. http://dx.doi.org/10.3390/jcdd9020044.

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(1) Background: Minimal invasive cardiac surgery via right anterolateral thoracotomy for heart valve surgery and other intracardiac procedures proven to have lower postoperative complications. We aim to compare the neurological complications and post-operative outcomes in two cohort groups as well as survival rates up to 5 years postoperatively; (2) Methodology: Retrospective observational study for patients who had minimally invasive cardiac valve surgery with retrograde femoral arterial perfusion between 2007 and 2021 (n = 596) and the categorized patients into two groups based on their age (≥70 years old and below 70). Propensity match analysis was conducted. The primary endpoint consisted of major postoperative complications and the secondary endpoint was the long-term survival rate. (3) Results: There was no difference between the two groups in terms of postoperative outcomes. Patients ≥ 70 years old had no increased risk for neurological complications (p = 0.75) compared with those below 70 years old. The mortality rate was also not significant between the two groups (p = 0.37) as well as the crude survival rates. (4) Conclusions: The use of retrograde femoral arterial perfusion in elderly patients is not associated with increased risk compared to the younger patients’ group for a spectrum of primary cardiac valve procedures. Hence, minimally invasive approaches could be offered to elderly patients who might benefit from it.

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Asemota, N., M. J. Rouhani, L. Harling, H. Raubenheimer, A. C. De Souza, and E. Lim. "Minimally Invasive Bilateral Lung Resections and CABG through 5 Ports." Case Reports in Surgery 2018 (December 13, 2018): 1–3. http://dx.doi.org/10.1155/2018/9659232.

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Minimal access surgery is increasingly popular to reduce postoperative morbidity and enhance recovery. We present a case of a patient who underwent bilateral minimally invasive thoracic and cardiac surgery. An 81-year-old woman was diagnosed with T1aN0M0 left upper lobe small-cell lung cancer and underwent single-port left video-assisted thoracoscopic surgery (VATS) upper lobectomy in 2016. She developed a contralateral right lower lobe nodule and underwent a single-port right VATS wedge resection of the lower lobe nodule, subsequently confirmed as necrotising granulomatous inflammation with acid-fast bacilli, consistent with previous tuberculosis (TB) infection. On postoperative day 1, she had an episode of self-reverting ventricular tachycardia and bradycardia. Subsequent myocardial perfusion scan and coronary angiogram showed significant LV dysfunction and severe coronary artery disease with a left main stem (LMS) lesion. After agreement at MDT, an Endo-ACAB (endoscopic atraumatic coronary artery bypass grafting) was performed, via 3 ports, with the left internal mammary artery anastomosed to left anterior descending artery. She recovered well postoperatively and was discharged. Multiple sequential minimally invasive procedures are now routine and can be performed safely in patients with a complex combination of pathologies. In this case, bilateral single-port (anatomic and nonanatomic) lung resections were undertaken followed by coronary revascularisation with a total of 5 minimal access ports.

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Kadner, Alexander, Paul Philipp Heinisch, Maris Bartkevics, Serena Wyss, Hans-Joerg Jenni, Gabor Erdoes, Balthasar Eberle, and Thierry Carrel. "Initial experiences with a centrifugal-pump based minimal invasive extracorporeal circulation system in pediatric congenital cardiac surgery." Journal of Thoracic Disease 11, S10 (June 2019): S1446—S1452. http://dx.doi.org/10.21037/jtd.2019.01.95.

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Sachde, Jigisha. "NEAR-INFRARED SPECTROSCOPY FOR MONITORING DISTAL LIMB PERFUSION DURING PEDIATRIC MINIMAL INVASIVE CARDIAC SURGERY FOR CONGENITAL HEART DEFECTS." Journal of Cardiothoracic and Vascular Anesthesia 35 (October 2021): S16—S17. http://dx.doi.org/10.1053/j.jvca.2021.08.062.

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Zoman, Hamad Al, Samer Al Jetaily, Asirvatham Alwin Robert, Jagan Kumar Baskaradoss, Abdulaziz Al-Suwyed, Sebastian Ciancio, and Sultan Al Mubarak. "Flapless Dental Implant Surgery for Patients on Oral Anticoagulants—The “WarLess Procedure”: A Report of 2 Cases." Journal of Oral Implantology 39, S1 (May 1, 2013): 264–70. http://dx.doi.org/10.1563/aaid-joi-d-11-00105.

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Patients with prosthetic heart valves are maintained on lifelong oral anticoagulant therapy. The optimal anticoagulant management of such patients during surgical dental procedures has been debated for a long time. Compared with conventional dental implant placement, a minimally invasive flapless approach has the potential to reduce bleeding and minimize surgical time, postoperative pain, soft tissue inflammation, and crestal bone. The purpose of these case reports is to show the clinical predictability of dental implant placement using a minimally invasive flapless approach without reducing the dosage of anticoagulants for patients on lifelong anticoagulant therapy. In this study, a 45-year-old woman and a 58-year-old man who had undergone cardiac surgery and were currently under a full therapeutic level of anticoagulation therapy (warfarin) were treated with flapless dental implant surgery without reducing their anticoagulant dosage. Postoperative clinical and radiographic assessment showed no abnormality, minimal signs of inflammation, and excellent healing. The combination of minimally invasive flapless dental implant surgery with no interruption in the normal dose of the anticoagulant medications could be an improved method for placing dental implants in patients on long-term anticoagulant therapy.

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Nasr, Mireille, Mikhael Kossaif, and Antoine Kossaify. "Pre-operative Cardiovascular Evaluation in elective Noncardiac Surgery, Risk Scores, and Managerial Insight for Patients with Different Cardiac Morbidities." Open Access Macedonian Journal of Medical Sciences 8, F (April 28, 2020): 41–51. http://dx.doi.org/10.3889/oamjms.2020.3372.

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Cardiac pre-operative evaluation must aim to estimate the perioperative cardiovascular risk, taking into consideration the individual clinical setting along with the type of surgery. Pre-operative assessment and management comprise evaluation of risk scores and the potential performance of some paraclinical tests to better prepare the patient for surgery. Pain management, adequate hydration, and thromboembolic prophylaxis constitute the main axis to decrease perioperative cardiovascular complications; moreover, the presence of previous cardiac conditions along with hypersympathetic activity is involved in a significant percentage of perioperative morbidity. Patients with minimal perioperative risk may not require systematically a cardiology consultation, whereas patients with moderate or high surgical risk often require a multidisciplinary approach for better perioperative management. The use of paraclinical tests to evaluate cardiac condition, such as cardiac biomarkers, echocardiogram, and other noninvasive or invasive cardiac testing, should be tailored on a case-by-case basis. Such professional practice aims to limit unnecessary healthcare expenses without compromising clinical outcome. Pre-operative surgical risk is not only based on cardiovascular condition but also on other factors and comorbidities such as diabetes, renal function, and functional status. In this regard, the role of the anesthesiologist is essential to evaluate the pre-operative risk (mild, moderate, or high), also to manage the whole perioperative period.

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Gatomski, Gregor, Hong Nhung Nguyen, Fabrizio Quadrini, and Andreas H. Foitzik. "Components of a Heart Catheter System for High Risk Patients." Materials Science Forum 879 (November 2016): 583–88. http://dx.doi.org/10.4028/www.scientific.net/msf.879.583.

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As late as fifteen years ago the intracardiac catheter was only used for diagnostic purposes. Since then it has also been established as a therapeutic method. The latest studies have shown that the reduction in convalescence that normally follows a catheter-interventional implantation of aortic valves by transcatheter aortic valve implantation is less significant in comparison to that of a cardiac surgery operation. It is expected that such minimal-invasive technologies will grow to a great extent, also helping to reduce socio-economic costs for the European health care system. Patients of higher ages with acquired cardiac defects or children with congenital cardiac defects of heart valves, especially of the pulmonary valve, are currently the main target groups. We present an alternative and optimized mechanism for stent placement and similar therapeutical interventions. This project focuses on the manipulation unit and tube system. It carries out a highly precise and repeatable linear motion. Ergonomic requirements are taken into account. Furthermore a possibility to support the linear motion by minimal strain is presented. The product is designed for disposable applications but is generally also suitable for long-term applications.

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von Segesser, Ludwig Karl, Denis Berdajs, Saad Abdel-Sayed, Piergiorgio Tozzi, Enrico Ferrari, and Francesco Maisano. "New, Virtually Wall-Less Cannulas Designed for Augmented Venous Drainage in Minimally Invasive Cardiac Surgery." Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 11, no. 4 (July 2016): 278–81. http://dx.doi.org/10.1097/imi.0000000000000283.

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Objective Inadequate venous drainage during minimally invasive cardiac surgery becomes most evident when the blood trapped in the pulmonary circulation floods the surgical field. The present study was designed to assess the in vivo performance of new, thinner, virtually wall-less, venous cannulas designed for augmented venous drainage in comparison to traditional thin-wall cannulas. Methods Remote cannulation was realized in 5 bovine experiments (74.0 ± 2.4 kg) with percutaneous venous access over the wire, serial dilation up to 18 F and insertion of either traditional 19 F thin wall, wire-wound cannulas, or through the same access channel, new, thinner, virtually wall-less, braided cannulas designed for augmented venous drainage. A standard minimal extracorporeal circuit set with a centrifugal pump and a hollow fiber membrane oxygenator, but no inline reservoir was used. One hundred fifty pairs of pump-flow and required pump inlet pressure values were recorded with calibrated pressure transducers and a flowmeter calibrated by a volumetric tank and timer at increasing pump speed from 1500 RPM to 3500 RPM (500-RPM increments). Results Pump flow accounted for 1.73 ± 0.85 l/min for wall-less versus 1.17 ± 0.45 l/min for thin wall at 1500 RPM, 3.91 ± 0.86 versus 3.23 ± 0.66 at 2500 RPM, 5.82 ± 1.05 versus 4.96 ± 0.81 at 3500 RPM. Pump inlet pressure accounted for 9.6 ± 9.7 mm Hg versus 4.2 ± 18.8 mm Hg for 1500 RPM, −42.4 ± 26.7 versus −123 ± 51.1 at 2500 RPM, and −126.7 ± 55.3 versus −313 ±116.7 for 3500 RPM. Conclusions At the well-accepted pump inlet pressure of −80 mm Hg, the new, thinner, virtually wall-less, braided cannulas provide unmatched venous drainage in vivo. Early clinical analyses have confirmed these findings.

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Kumar, Gideon Praveen, and Lazar Mathew. "ANALYSIS OF THE PHYSICAL BEHAVIOR OF A HOOKED TITANIUM BASED PERCUTANEOUS AORTIC VALVE STENT." Biomedical Engineering: Applications, Basis and Communications 24, no. 04 (August 2012): 323–26. http://dx.doi.org/10.4015/s101623721250024x.

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Vascular support structures are important devices for treating valve stenosis. Large population of patients is treated for valvular disease and the principal mode of treatment is the use of percutaneous valvuloplasty. Stent devices are proving to be an improved technology in minimal invasive cardiac surgery. This technology now accounts for 20% of treatments in Europe. This new technology provides highly effective results at minimal cost and short duration of hospitalization. During the development process, a number of specific designs and materials have come and gone, and a few have remained. Many design changes were successful, and many were not. This paper discusses the physical behavior of a hooked percutaneous aortic valve stent design using finite element analysis using a new Titanium alloy. The analysis performed in this paper may aid in understanding the stent's displacement ranges when subjected to the physiological pressures exerted by the heart and cardiac blood flow during abnormal cardiovascular conditions. It may also help to evaluate the suitability of a new titanium alloy for fabrication purposes.

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Graßler, Angelika, Robert Bauernschmitt, Irene Guthoff, Andreas Kunert, Markus Hoenicka, Günter Albrecht, and Andreas Liebold. "Effects of pulsatile minimal invasive extracorporeal circulation on fibrinolysis and organ protection in adult cardiac surgery—a prospective randomized trial." Journal of Thoracic Disease 11, S10 (June 2019): S1453—S1463. http://dx.doi.org/10.21037/jtd.2019.02.66.

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Coppoolse, Ruud, Wolfgang Rees, Rainer Krech, Michael Hufnagel, Kristin Seufert, and Henning Warnecke. "Routine minimal invasive vein harvesting reduces postoperative morbidity in cardiac bypass procedures. Clinical report of 1400 patients." European Journal of Cardio-Thoracic Surgery 16, Supplement_2 (November 1999): S61—S66. http://dx.doi.org/10.1093/ejcts/16.supplement_2.s61.

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Maessen, J. G., B. Phelps, A. L. A. J. Dekker, and B. Dijkman. "Minimal invasive epicardial lead implantation: optimizing cardiac resynchronization with a new mapping device for epicardial lead placement☆." European Journal of Cardio-Thoracic Surgery 25, no. 5 (May 2004): 894–96. http://dx.doi.org/10.1016/j.ejcts.2004.01.055.

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COPPOOLSE, R. "Routine minimal invasive vein harvesting reduces postoperative morbidity in cardiac bypass procedures. Clinical report of 1400 patients*1." European Journal of Cardio-Thoracic Surgery 16 (November 1999): S61—S66. http://dx.doi.org/10.1016/s1010-7940(99)00272-9.

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Salman, Jawad, Jamshid Naqizadah, Murat Avsar, Malakh Shrestha, Gregor Warnecke, Issam Ismail, Stefan Rümke, et al. "Minimally Invasive Mitral Valve Surgery in Re-Do Cases—The New Standard Procedure?" Thoracic and Cardiovascular Surgeon 66, no. 07 (February 28, 2018): 545–51. http://dx.doi.org/10.1055/s-0038-1627478.

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Background Minimally invasive mitral valve surgery (MIMVS) is superior to “classical” mitral valve surgery via a sternotomy regarding wound healing and postoperative pain. It is however a more challenging procedure. Patients' preference is leading clearly toward minimally invasive approaches, and surgeons are driven by upcoming new technologies in interventional procedures such as the MitraClip. Especially in re-do cases, the access via right mini-thoracotomy, as previously non-operated situs, is a possible advantage over a re-sternotomy. We therefore retrospectively analyzed our result regarding MIMVS in re-do cases at our institute. Methods From January 2011 and June 2016, 33 operations were MIMVS re-do procedures. Mean age was 60 years (±16 years), and 51% were male. Results Sixty-one percent were elective cases, 29% were urgent cases, and 9% were emergency operations. Operation times, cardiopulmonary bypass (CPB) times, and clamp times were 235 minutes (±51 min), 149 minutes (±42 min), and 62 minutes (±45min), respectively. Mitral valve repair and replacement was performed in 24% (n = 8) and 76% (n = 25), respectively. Overall in-hospital mortality, apoplexy, and re-operation rates (all for bleeding) were 0% (n = 0), 3% (n = 1), and 9% (n = 3). New onset of dialysis was required in two (6%) patients. Two (6%) patients developed superficial wound infection. Overall intensive care unit (ICU) and hospital stay was 3 days (±4 days) and 15 days (±7 days), respectively. Conclusion MIMVS for re-do cases can be performed with minimal mortality and morbidity and therefore represents a safe alternative to conventional mitral valve surgery in cardiac re-do operations. However, postoperative morbidity is highly dependent on preoperative patient status.

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Abdelbar, Abdelrahman, Gunaratnam Niranjan, Charlene Tennyson, Palanikumar Saravanan, Andrew Knowles, Grzegorz Laskawski, and Joseph Zacharias. "Endoscopic Tricuspid Valve Surgery is a Safe and Effective Option." Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 15, no. 1 (January 5, 2020): 66–73. http://dx.doi.org/10.1177/1556984519887946.

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Objective Isolated tricuspid surgery through median sternotomy can be associated with a high morbidity and mortality. Reports of minimally invasive isolated tricuspid valve operations are rare, but the outcomes are encouraging. We present our experience of endoscopic isolated tricuspid valve surgery. Methods In our institution, 452 patients underwent endoscopic minimal access cardiac surgery between August 2008 and December 2018. A total of 90 patients underwent tricuspid valve surgery whether isolated or with other cardiac procedure. We further selected patients who had isolated tricuspid valve surgery ( n = 24). Of these patients, 13 (54%) had more than one previous sternotomy. Results Tricuspid repair was performed in 18 patients (75%) with the remaining 6 (25%) having bioprosthetic tricuspid replacement. Three (12.5%) were performed with a beating heart, the remaining with endoaortic clamping and cardioplegia. There were no conversions to sternotomy. None of the patients had reoperation for bleeding, tamponade, or valve issues. Three patients (12.5%) required blood transfusion, 3 patients (12.5%) required renal dialysis, and 7 patients (29%) had respiratory complications such as chest infection, requiring continuous positive airway pressure (CPAP) with 2 being re-intubated. One patient (4.1%) died within 30 days from chest sepsis leading to multi-organ failure. Mean hospital stay was 11.1 ± 8.9 days (median of 8). All patients had mild or less regurgitation on follow-up echo at 6 months. Conclusions Isolated tricuspid valve surgery can be performed through an endoscopic minimally access approach, with good results. It appears to provide better results than a sternotomy approach. A high repair rate can be achieved, and the procedure is particularly valuable in redo-surgery with low mortality and morbidity compared to historical sternotomy case series.

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Marler, Adam T., Jamil A. Malik, and Ahmad M. Slim. "Anomalous Left Main Coronary Artery: Case Series of Different Courses and Literature Review." Case Reports in Vascular Medicine 2013 (2013): 1–5. http://dx.doi.org/10.1155/2013/380952.

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Background. Congenital anomalies of the coronary arteries are a cause of sudden cardiac death. Of the known anatomic variants, anomalous origination of a coronary artery from an opposite sinus of Valsalva (ACAOS) remains the main focus of debate.Case Series. We present three cases, all presenting to our facility within one week’s time, of patients with newly discovered anomalous origination of the left coronary artery from the right sinus of Valsalva (L-ACAOS). All patients underwent cardiac computed tomography for evaluation of coronary anatomy along with other forms of functional testing. Despite the high risk nature of two of the anomalies, the patients are being treated medically without recurrence of symptoms.Summary. After review of the literature, we have found that the risk of sudden cardiac death in patients with congenital coronary anomalies, even among variants considered the highest risk, may be overestimated. In addition, the exact prevalence of coronary anomalies in the general population is currently underestimated. A national coronary artery anomaly registry based on cardiac computed tomography and invasive coronary angiography data would be helpful in advancing our understanding of these cardiac peculiarities. The true prevalence of congenital coronary anomalies and overall risk of sudden cardiac death in this population are not well known. Surgical intervention remains the mainstay of therapy in certain patients though recent investigations into the pathophysiology of these abnormalities have shown that the risk of surgery may outweigh the minimal reduction in risk of sudden cardiac death.

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