Minimally Invasive Approach for Complex Cardiac Surgery Procedures

Pasquale Totaro, Simone Carlini, Matteo Pozzi, Francesco Pagani, Giuseppe Zattera, Andrea Maria D'Armini, Mario Vigano

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Background: A minimally invasive approach through an upper ministernotomy (UMS) has been used in our Division since 1997. On the basis of favorable outcome we have gradually extended this approach from isolated aortic valve replacement (AVR) to more complex cardiac surgery procedures and it is currently our first choice for a variety of procedures. Here we report our 11 years experience. Methods: From 1997 to December 2007, 1,126 procedures were performed at our department, using UMS. Isolated procedures on the aortic valve were performed in 695 patients (61%). Isolated procedures on the aortic valve as redo operation were performed in 77 patients (7%). Complex cardiac surgery procedures (including double valve replacement-repair, ascending aorta-aortic arch replacement, aortic root replacement, aortic dissection, AVR combined with coronary surgery, and complex redo procedures) were performed in 354 patients (32%). Early postoperative outcome was evaluated considering three different groups according to the surgical procedure (first time AVR, redo AVR, and complex procedure). Results: Overall conversion to full sternotomy was required in 16 patients (1.4%) with no significant differences between isolated AVR (9 patients, 1.3%) and complex or redo procedures (1 patient [1.2%] and 6 patients [1.6%], respectively). Forty-seven patients died in hospital (cumulative in-hospital mortality of 4.1 %). Mortality according to the procedure was 6.7, 3.8, and 2.8% for complex, redo AVR, or isolated AVR procedures, respectively, with a significant difference only for the complex procedures. Similarly, early postoperative outcome in terms of incidence of prolonged mechanical ventilation and ICU stay was significantly different only in the complex procedure group. Incidence of surgical revision (5.1, 2.9, and 2.7% for complex, redo, or isolated AVR procedures, respectively) showed no statistically significant differences regardless the type of procedures. Conclusions: Our experience clearly shows that a minimally invasive approach through upper ministernotomy is feasible and safe not only for isolated AVR but that it can also be utilized for a variety of complex surgical procedures. Minimizing surgical access may be helpful in patients undergoing complex surgical procedures, especially redo procedures, without compromising the surgical result.

Original languageEnglish
Pages (from-to)462-467
Number of pages6
JournalAnnals of Thoracic Surgery
Volume88
Issue number2
DOIs
Publication statusPublished - Aug 2009

Fingerprint

Thoracic Surgery
Aortic Valve
Sternotomy
Incidence
Hospital Mortality
Thoracic Aorta
Reoperation
Artificial Respiration

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Minimally Invasive Approach for Complex Cardiac Surgery Procedures. / Totaro, Pasquale; Carlini, Simone; Pozzi, Matteo; Pagani, Francesco; Zattera, Giuseppe; D'Armini, Andrea Maria; Vigano, Mario.

In: Annals of Thoracic Surgery, Vol. 88, No. 2, 08.2009, p. 462-467.

Research output: Contribution to journalArticle

@article{d91c09db5a2d42358ebda4cd605d5819,
title = "Minimally Invasive Approach for Complex Cardiac Surgery Procedures",
abstract = "Background: A minimally invasive approach through an upper ministernotomy (UMS) has been used in our Division since 1997. On the basis of favorable outcome we have gradually extended this approach from isolated aortic valve replacement (AVR) to more complex cardiac surgery procedures and it is currently our first choice for a variety of procedures. Here we report our 11 years experience. Methods: From 1997 to December 2007, 1,126 procedures were performed at our department, using UMS. Isolated procedures on the aortic valve were performed in 695 patients (61{\%}). Isolated procedures on the aortic valve as redo operation were performed in 77 patients (7{\%}). Complex cardiac surgery procedures (including double valve replacement-repair, ascending aorta-aortic arch replacement, aortic root replacement, aortic dissection, AVR combined with coronary surgery, and complex redo procedures) were performed in 354 patients (32{\%}). Early postoperative outcome was evaluated considering three different groups according to the surgical procedure (first time AVR, redo AVR, and complex procedure). Results: Overall conversion to full sternotomy was required in 16 patients (1.4{\%}) with no significant differences between isolated AVR (9 patients, 1.3{\%}) and complex or redo procedures (1 patient [1.2{\%}] and 6 patients [1.6{\%}], respectively). Forty-seven patients died in hospital (cumulative in-hospital mortality of 4.1 {\%}). Mortality according to the procedure was 6.7, 3.8, and 2.8{\%} for complex, redo AVR, or isolated AVR procedures, respectively, with a significant difference only for the complex procedures. Similarly, early postoperative outcome in terms of incidence of prolonged mechanical ventilation and ICU stay was significantly different only in the complex procedure group. Incidence of surgical revision (5.1, 2.9, and 2.7{\%} for complex, redo, or isolated AVR procedures, respectively) showed no statistically significant differences regardless the type of procedures. Conclusions: Our experience clearly shows that a minimally invasive approach through upper ministernotomy is feasible and safe not only for isolated AVR but that it can also be utilized for a variety of complex surgical procedures. Minimizing surgical access may be helpful in patients undergoing complex surgical procedures, especially redo procedures, without compromising the surgical result.",
author = "Pasquale Totaro and Simone Carlini and Matteo Pozzi and Francesco Pagani and Giuseppe Zattera and D'Armini, {Andrea Maria} and Mario Vigano",
year = "2009",
month = "8",
doi = "10.1016/j.athoracsur.2009.04.060",
language = "English",
volume = "88",
pages = "462--467",
journal = "Annals of Thoracic Surgery",
issn = "0003-4975",
publisher = "The Society of Thoracic Surgeons. Published by Elsevier Inc",
number = "2",

}

TY - JOUR

T1 - Minimally Invasive Approach for Complex Cardiac Surgery Procedures

AU - Totaro, Pasquale

AU - Carlini, Simone

AU - Pozzi, Matteo

AU - Pagani, Francesco

AU - Zattera, Giuseppe

AU - D'Armini, Andrea Maria

AU - Vigano, Mario

PY - 2009/8

Y1 - 2009/8

N2 - Background: A minimally invasive approach through an upper ministernotomy (UMS) has been used in our Division since 1997. On the basis of favorable outcome we have gradually extended this approach from isolated aortic valve replacement (AVR) to more complex cardiac surgery procedures and it is currently our first choice for a variety of procedures. Here we report our 11 years experience. Methods: From 1997 to December 2007, 1,126 procedures were performed at our department, using UMS. Isolated procedures on the aortic valve were performed in 695 patients (61%). Isolated procedures on the aortic valve as redo operation were performed in 77 patients (7%). Complex cardiac surgery procedures (including double valve replacement-repair, ascending aorta-aortic arch replacement, aortic root replacement, aortic dissection, AVR combined with coronary surgery, and complex redo procedures) were performed in 354 patients (32%). Early postoperative outcome was evaluated considering three different groups according to the surgical procedure (first time AVR, redo AVR, and complex procedure). Results: Overall conversion to full sternotomy was required in 16 patients (1.4%) with no significant differences between isolated AVR (9 patients, 1.3%) and complex or redo procedures (1 patient [1.2%] and 6 patients [1.6%], respectively). Forty-seven patients died in hospital (cumulative in-hospital mortality of 4.1 %). Mortality according to the procedure was 6.7, 3.8, and 2.8% for complex, redo AVR, or isolated AVR procedures, respectively, with a significant difference only for the complex procedures. Similarly, early postoperative outcome in terms of incidence of prolonged mechanical ventilation and ICU stay was significantly different only in the complex procedure group. Incidence of surgical revision (5.1, 2.9, and 2.7% for complex, redo, or isolated AVR procedures, respectively) showed no statistically significant differences regardless the type of procedures. Conclusions: Our experience clearly shows that a minimally invasive approach through upper ministernotomy is feasible and safe not only for isolated AVR but that it can also be utilized for a variety of complex surgical procedures. Minimizing surgical access may be helpful in patients undergoing complex surgical procedures, especially redo procedures, without compromising the surgical result.

AB - Background: A minimally invasive approach through an upper ministernotomy (UMS) has been used in our Division since 1997. On the basis of favorable outcome we have gradually extended this approach from isolated aortic valve replacement (AVR) to more complex cardiac surgery procedures and it is currently our first choice for a variety of procedures. Here we report our 11 years experience. Methods: From 1997 to December 2007, 1,126 procedures were performed at our department, using UMS. Isolated procedures on the aortic valve were performed in 695 patients (61%). Isolated procedures on the aortic valve as redo operation were performed in 77 patients (7%). Complex cardiac surgery procedures (including double valve replacement-repair, ascending aorta-aortic arch replacement, aortic root replacement, aortic dissection, AVR combined with coronary surgery, and complex redo procedures) were performed in 354 patients (32%). Early postoperative outcome was evaluated considering three different groups according to the surgical procedure (first time AVR, redo AVR, and complex procedure). Results: Overall conversion to full sternotomy was required in 16 patients (1.4%) with no significant differences between isolated AVR (9 patients, 1.3%) and complex or redo procedures (1 patient [1.2%] and 6 patients [1.6%], respectively). Forty-seven patients died in hospital (cumulative in-hospital mortality of 4.1 %). Mortality according to the procedure was 6.7, 3.8, and 2.8% for complex, redo AVR, or isolated AVR procedures, respectively, with a significant difference only for the complex procedures. Similarly, early postoperative outcome in terms of incidence of prolonged mechanical ventilation and ICU stay was significantly different only in the complex procedure group. Incidence of surgical revision (5.1, 2.9, and 2.7% for complex, redo, or isolated AVR procedures, respectively) showed no statistically significant differences regardless the type of procedures. Conclusions: Our experience clearly shows that a minimally invasive approach through upper ministernotomy is feasible and safe not only for isolated AVR but that it can also be utilized for a variety of complex surgical procedures. Minimizing surgical access may be helpful in patients undergoing complex surgical procedures, especially redo procedures, without compromising the surgical result.

UR - http://www.scopus.com/inward/record.url?scp=67650729340&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=67650729340&partnerID=8YFLogxK

U2 - 10.1016/j.athoracsur.2009.04.060

DO - 10.1016/j.athoracsur.2009.04.060

M3 - Article

C2 - 19632394

AN - SCOPUS:67650729340

VL - 88

SP - 462

EP - 467

JO - Annals of Thoracic Surgery

JF - Annals of Thoracic Surgery

SN - 0003-4975

IS - 2

ER -