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minimal invasive coronary surgery

Benedikt Mayr, Christian Firschke, Magdalena Erlebach, Sabine Bleiziffer, Markus Krane, Michael Joner, Ulf Herold, Christian Nöbauer, Rüdiger Lange, Marcus-André Deutsch
OBJECTIVES: Simultaneous surgical off-pump coronary revascularization and transcatheter aortic valve implantation (TAVI) as a hybrid procedure may be a therapeutic option for patients with a TAVI indication who are not suitable for percutaneous coronary intervention and for patients who have an indication for combined surgical aortic valve implantation and coronary artery bypass grafting but present with a porcelain aorta. Early outcomes of these patients are analysed in this study. METHODS: From February 2011 to April 2017, hybrid TAVI/off-pump coronary artery bypass (OPCAB) was performed in 12 (60%) patients, hybrid TAVI/minimally invasive direct coronary artery bypass in 6 (30%) patients and staged TAVI/OPCAB in 2 (10%) patients...
February 26, 2018: Interactive Cardiovascular and Thoracic Surgery
Shakil Farid, Jason M Ali, Victoria Stohlner, Ruhina Alam, Peter Schofield, Samer Nashef, Ravi De Silva
OBJECTIVE: The primary objective was to investigate the long-term survival of patients who underwent single-vessel coronary revascularization with minimally invasive direct coronary artery bypass surgery with or without hybrid revascularization. The secondary outcome measures were repeat revascularization either by coronary artery bypass grafting or by percutaneous coronary intervention and the incidence of myocardial infarction or recurrent angina. METHODS: This is a retrospective study of prospectively collected data of patients who underwent minimally invasive direct coronary artery bypass procedure in our center between January 2001 and December 2015...
January 2018: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
Marco Moscarelli, Nora Terrasini, Anna Nunziata, Prakash Punjabi, Gianni Angelini, Marco Solinas, Alba Buselli, Paolo Del Sarto, Dorela Haxhiademi
OBJECTIVE: Minimally invasive mitral valve repair may be associated with prolonged cardioplegic arrest times and ischemic reperfusion injury. Intravenous (propofol) and volatile (sevoflurane) anesthesia are used routinely during cardiac surgery and are thought to provide cardioprotection; however, the individual contribution of each regimen to cardioprotection is unknown. Therefore, the authors sought to compare the cardioprotective effects of propofol and sevoflurane anesthesia in patients undergoing minimally invasive mitral valve repair...
January 31, 2018: Journal of Cardiothoracic and Vascular Anesthesia
Shirin Siddiqi, Eugene H Blackstone, Faisal G Bakaeen
A variety of cardioplegic solutions are being used widely today to arrest the heart during coronary artery bypass grafting (CABG) and other cardiac operations. To minimize interruptions during the surgery for intermittent dosing of the cardioplegia and to facilitate less invasive cardiac procedures, single-shot solutions, including Bretschneider and del Nido solutions, have been introduced. This review examines the evidence regarding the safety and efficacy of Bretschneider and del Nido cardioplegia during CABG...
February 14, 2018: Journal of Cardiac Surgery
Francesco Onorati, Riccardo Gherli, Giovanni Mariscalco, Evaldas Girdauskas, Eduardo Quintana, Francesco Santini, Marisa De Feo, Sandro Sponga, Piergiorgio Tozzi, Mohamad Bashir, Andrea Perrotti, Aniello Pappalardo, Vito Ruggieri, Giuseppe Santarpino, Mauro Rinaldi, Silva Ronaldo, Francesco Nicolini
INTRODUCTION: Traditional and transcatheter surgical treatments of severe aortic valve stenosis (SAVS) are increasing in parallel with the improved life expectancy. Recent randomised controlled trials (RCTs) reported comparable or non-inferior mortality with transcatheter treatments compared with traditional surgery. However, RCTs have the limitation of being a mirror of the predefined inclusion/exclusion criteria, without reflecting the 'real clinical world'. Technological improvements have recently allowed the development of minimally invasive surgical accesses and the use of sutureless valves, but their impact on the clinical scenario is difficult to assess because of the monocentric design of published studies and limited sample size...
February 10, 2018: BMJ Open
Dong Hyun Seo, Jun Sung Kim, Kay-Hyun Park, Cheong Lim, Su Ryeun Chung, Dong Jung Kim
Background: Minimally invasive direct coronary artery bypass grafting (MIDCAB) has the advantage of allowing arterial grafting on the left anterior descending artery without a sternotomy incision. We present our single-center clinical experience of 66 consecutive patients. Methods: All patients underwent MIDCAB through a left anterior small thoracotomy between August 2007 and July 2015. Preoperative, intraoperative, postoperative and follow-up data-including major adverse cardiovascular and cerebrovascular events (MACCE), graft patency, and the need for re-intervention-were collected...
February 2018: Korean Journal of Thoracic and Cardiovascular Surgery
Vincenzo Giambruno, Michael W Chu, Cristina Cucchietti, Douglas W Boyd, Bob Kiaii
BACKGROUND: Minimally invasive robot-assisted direct coronary artery bypass (RADCAB) has emerged as a feasible minimally invasive surgical technique for revascularization that might offer several potential advantages over conventional approaches. We present our 18-year experience in RADCAB. METHODS: Between February 1998 and February 2016, 605 patients underwent RADCAB. Patients underwent post-procedural selective graft patency assessment using cardiac catheterization...
January 19, 2018: International Journal of Medical Robotics + Computer Assisted Surgery: MRCAS
Kevin Fleming, Roberta E Redfern, Rebekah L March, Nathan Bobulski, Michael Kuehne, John T Chen, Michael Moront
Complex cardiac procedures often require blood transfusion because of surgical bleeding or coagulopathy. Thrombelastography (TEG) was introduced in our institution to direct transfusion management in cardiothoracic surgery. The goal of this study was to quantify the effect of TEG on transfusion rates peri- and postoperatively. All patients who underwent complex cardiac surgery, defined as open multiple valve repair/replacement, coronary artery bypass grafting with open valve repair/replacement, or aortic root/arch repair before and after implementation of TEG were identified and retrospectively analyzed...
December 2017: Journal of Extra-corporeal Technology
Adrian Bauer, Harald Hausmann, Jan Schaarschmidt, Michal Szlapka, Martin Scharpenberg, Thomas Eberle, J Michael Hasenkam
INTRODUCTION:  The recommended minimum activated clotting time (ACT) level for cardiopulmonary bypass (CPB) of 480 seconds originated from investigations with bubble oxygenators and uncoated extracorporeal circulation (ECC) systems. Modern minimal invasive ECC (MiECC) systems are completely closed circuits containing a membrane oxygenator and a tip-to-tip surface coating. We hypothesized that surface coating and the "closed-loop" design allow the MiECC to safely run with lower ACT levels and that an ACT level of 300 seconds can be safely applied without thromboembolic complications...
December 31, 2017: Thoracic and Cardiovascular Surgeon
Faisal Bakaeen
Use of coronary artery bypass grafting (CABG) has had a resurgence, as clinical trial data emerged showing that it remains the standard of care for patients with complex lesions. Debate exists regarding various factors, including endoscopic vs open vein-graft harvesting, single vs bilateral mammary artery grafts, radial artery vs saphenous vein grafts, right internal mammary artery vs radial artery grafts, and on-pump vs off-pump surgery. More recent developments include minimally invasive approaches, robotics, and hybrid revascularization, which are changing the risk-benefit ratio for this patient population...
December 2017: Cleveland Clinic Journal of Medicine
Torsten Doenst, Mahmoud Diab, Christoph Sponholz, Michael Bauer, Gloria Färber
BACKGROUND: Over the past two decades, minimally invasive techniques for classic heart valve surgery and isolated bypass surgery have been developed that enable access to the heart via partial sternotomy for most aortic valve procedures and via sternotomy-free mini-thoracotomy for other procedures. METHODS: We review the current evidence on minimally invasive cardiac surgery on the basis of pertinent randomized studies and database studies retrieved by a selective search in the MEDLINE and PubMed Central databases, as well as by the Google Scholar search engine...
November 17, 2017: Deutsches Ärzteblatt International
Jean-Sébastien Lebon, Pierre Couture, Annik Fortier, Antoine G Rochon, Christian Ayoub, Claudia Viens, Éric Laliberté, Denis Bouchard, Michel Pellerin, Alain Deschamps
OBJECTIVE: To compare antegrade and retrograde cardioplegia administration in minimally invasive mitral valve surgery (MIMS) and open mitral valve surgery (OMS) for myocardial protection. DESIGN: Retrospective study. SETTING: Tertiary care university hospital. PARTICIPANTS: The study comprised 118 patients undergoing MIMS and 118 patients undergoing OMS. INTERVENTIONS: The data of patients admitted for MIMS from 2006 to 2010 were reviewed...
August 30, 2017: Journal of Cardiothoracic and Vascular Anesthesia
Rachel M Easterwood, Ian C Bostock, Shruthi Nammalwar, Jock N McCullough, Alexander Iribarne
The field of minimally invasive cardiac surgery has undergone rapid transformation over recent years. In this review, we provide a summary of the most current evidence supporting the use of minimally invasive aortic and mitral valve replacement techniques, as well as transcatheter approaches for aortic and mitral valve disease. As an adjunct, the use of robotically assisted coronary bypass surgery and hybrid coronary revascularization procedures is discussed. In order to obtain optimal patient outcomes, a collaborative, heart-team approach between cardiac surgeons and interventional cardiologists is necessary...
January 2018: Future Cardiology
Pradeep Nambiar, Sanjay Kumar, Chander Mohan Mittal, Kailash Saksena
OBJECTIVE: The aim was to show that total arterial revascularization via a left minithoracotomy using bilateral internal thoracic arteries was not only feasible but also a safe and reproducible procedure with excellent midterm outcomes. METHODS: From August 2011 to August 2016, 819 patients underwent off-pump minimally invasive multivessel coronary artery bypass grafting using bilateral internal thoracic arteries harvested through a 2-inch left minithoracotomy incision, and complete revascularization of the myocardium was performed using the left internal thoracic artery-right internal thoracic artery Y composite conduit...
January 2018: Journal of Thoracic and Cardiovascular Surgery
Andrés M Pineda, Christos G Mihos, Juan P Rodriguez-Escudero, Joseph Lamelas, Nirat Beohar, Orlando Santana
BACKGROUND: A subset of patients requiring coronary revascularization of the proximal left anterior descending coronary artery (LAD) and valve surgery may benefit from a staged approach, rather than combined median sternotomy coronary artery bypass graft (CABG) and valve surgery. METHODS: A retrospective evaluation was made of the outcomes of patients with significant proximal LAD and valvular heart disease undergoing a staged approach of percutaneous coronary intervention (PCI) followed by minimally invasive valve surgery (MIVS) at the authors' institution between February 2009 and April 2014...
May 2017: Journal of Heart Valve Disease
Vinayak Bapat
Transcatheter aortic valve implantation (TAVI) has emerged as a viable treatment modality for patients with severe aortic valve stenosis and multiple co-morbidities. More recent indications include the use of transcatheter heart valves (THV) to treat degenerated bioprosthetic surgical heart valves (SHV), which are failing due to stenosis or regurgitation. Valve-in-valve (VIV) procedures in the aortic position have been performed with a variety of THV devices, although the balloon-expandable SAPIEN valve platform (Edwards Lifesciences Ltd, Irvine, CA, USA) and self-expandable CoreValve platform (Medtronic Inc...
September 2017: Annals of Cardiothoracic Surgery
Ali İhsan Tekin, Ümit Arslan
INTRODUCTION: Surgical treatment of isolated left anterior descending coronary artery disease can be performed with either minimally invasive direct coronary artery bypass via a left anterior thoracotomy (MIDCAB) or off-pump coronary artery bypass via a median sternotomy (OPCAB). AIM: To compare the perioperative outcomes of patients undergoing MIDCAB or OPCAB surgery. MATERIAL AND METHODS: Patients who underwent either MIDCAB or OPCAB for isolated left anterior descending (LAD) coronary artery disease between October 2013 and December 2015 were retrospectively evaluated...
September 2017: Wideochirurgia i Inne Techniki Mało Inwazyjne, Videosurgery and Other Miniinvasive Techniques
Francis D Ferdinand, John K MacDonald, Husam H Balkhy, Gianluigi Bisleri, Ho Young Hwang, Patricia Northrup, Richard H J Trimlett, Lai Wei, Bob B Kiaii
OBJECTIVE: The purpose of this consensus conference was to develop and update evidence-informed consensus statements and recommendations on harvesting saphenous vein and radial artery via an open as compared with endoscopic technique by systematically reviewing and performing a meta-analysis of randomized and nonrandomized clinical trials. METHODS: All randomized controlled trials and nonrandomized controlled trials included in the first the International Society for Minimally Invasive Cardiothoracic Surgery Consensus Conference and Statements, in 2005 up to November 30, 2015, were included in a systematic review and meta-analysis...
September 2017: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
Christopher L Tarola, Hussein A Al-Amodi, Sankar Balasubramanian, Stephanie A Fox, Christopher C Harle, Ivan Iglesias, Kumar Sridhar, Patrick J Teefy, Michael W A Chu, Bob B Kiaii
OBJECTIVE: Contemporary anesthetic techniques have enabled shorter sedation and early extubation in off-pump and minimally invasive coronary artery bypass (CABG) surgery. Robotic-assisted CABG represents the optimal surgical approach for ultrafast track anesthesia, with patients able to bypass the cardiac surgical intensive care unit with recovery in the postanesthesia care unit (PACU) and inpatient ward. METHODS: In-hospital postoperative outcomes from ninety patients who underwent either elective or urgent robotically-assisted CABG at our institution were reviewed...
September 2017: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
Kristof Nijs, Jeroen Vandenbrande, Fidel Vaqueriza, Jean-Paul Ory, Alaaddin Yilmaz, Pascal Starinieri, Jasperina Dubois, Luc Jamaer, Ingrid Arijs, Björn Stessel
INTRODUCTION: Adverse 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...
October 6, 2017: BMJ Open
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