clinical professor, director of cardiovascular surgery ......modern cardiac operations increasingly...
TRANSCRIPT
Serdar Gunaydin, MD, PhDClinical Professor,
Director of Cardiovascular Surgery,Numune Training & Research Hospital,
University of Health Sciences,Ankara-Turkey
No Disclosures
✓ Modern cardiac operations increasingly use minimallyinvasive techniques, such as less invasive incisions andapproaches, and extracorporeal support is often reduced oreven avoided
✓ Even so, less than 20% of isolated aortic valve proceduresand about 45% of isolated mitral valve operations in Germany are performed in a minimally invasive fashion
✓ In contrast, approximately 4% of cardiopulmonary supportis minimally invasive in Europe
✓ Innovations in alternative methods for cannulation and cardiopulmonary bypass (CPB), new visualization systems, retractors and stabilizers, and robotic platformshave facilitated the development of minimally invasive cardiac surgery
✓ Complications associated with the endoclamp include balloon migration/ruptureand retrograde aortic dissection
✓ Elevated atherosclerotic plaques greater than 2 mm in height in the descendingthoracic aorta or arch may increase the risk of retrograde cerebral and othersystemic embolization and constitutes a contraindication to femoral artery-perfused minimally invasive mitral valve surgery
✓ Relative contraindications for a mini-right thoracotomy mitral approach includeprevious right thoracotomy with dense pleural adhesions, significant obesity, severe chest deformity (e.g., pectus excavatum), scoliosis, and prior breast implantor reconstruction
✓ Other operations that can be performed through a small right thoracotomy includetricuspid valve surgery, atrial septal defect closure, atrial myxoma resection, andseptal myectomy
✓ Minimally invasive approaches for aortic valve surgery generally consist of limitedsternotomies
➢ May-August 2017
➢ 20 Cases (16 female, Age: 76∓8.2)
➢ 17 AVR, 2 ASD, 1 MVR
➢ J-Sternotomy (5), R.Ant. Thoracotomy (15)
➢ Central Cannulation (8), Femoral (8), Femoral+Jugular (4)
➢ ICU: 1.2 ∓ 0.2 days
➢ Blood Tx : 0.4 ∓ 0.03 U (No Tx in 13 cases)
➢ LOS: 4.2 ∓ 1.3 days
✓ VAVD (-20/-40mmHg)
✓ Single dose Cardioplegia(Del Nido/HTK)
✓ NIRS
✓ RAP
✓ Cell-saver/HemoSep
MiECC Features
MICS• Equivalent early/late clinical
outcome
• Less pain, blood tx, wound infection
• Shorter LOS
• Better cosmetics
• Better results in high-risk patients
• Reoperations
• Easy penetration into a cost-sensitive environment
MiECC▪ A complete physiologically-based
strategy and not just a CPB circuit or a particular product
▪ All types of complicated cardiacsurgery
▪ Destination therapy: Bridge-to-bridge, bridge-to-transplant, orbridge-to-recovery
▪ Postcardiotomy cardiogenic shock, high-risk cardiology interventions, pulmonary embolism, myocarditisand accidental hypothermia
▪ Closed chest temporary mini-CPBusing peripheral cardiopulmonary bypass (salvage approach in patients with cardiogenic shock or cardiopulmonary arrest)
▪ Commercially available device thatcombines portability, rapid and easy deployment, and safe operation, withadaptability to various applications and patient requirements, along withlow cost
• No clear scientific evidnce due tomethodologic concerns: small numberof high-risk patients, surrogate endpoints, confounding factors
• The strong interest might be accountedfor the expected reductions in mortalityin subgroups of patients of highher risk with comorbidities
• New, large randomized controlled trialswill clarify this intriguing aspect