The periareolar access has been the preferred technique used at our institution for minimally invasive cardiac surgery since 2006. The surgical approach consists of video-assisted minithoracotomy in the 4th right intercostal space, through a periareolar incision. Initially, the technique was restricted to minimally invasive mitral valve surgeries but, due to its feasibility and safety, was soon incorporated as an ideal access for other cardiac pathologies such as tricuspid valve disease, atrial septal defect, atrial fibrillation, and pacemaker leads endocarditis. The technique was performed in 214 patients, and it is associated with excellent aesthetic and functional results, with low morbimortality and no reoperations at long-term follow-up. Here, we describe and support the use of periareolar access as a routine surgical technique for correction of several cardiac pathologies, especially in women.

Results: The surgical procedures were: plasty (n=20) or mitral valve replacement (n=36), aortic valve replacement (n=14), atrioseptoplasty using pericardial patch (n=32), tricuspid valve repair with rigid ring (n=6) and surgical correction of atrial fibrillation with radiofrequency (n=12). There were no complications during the procedures. There was no conversion to thoracotomy in neither case. Two patients developed atrial fibrillation in the postoperative period. There was an episode of stroke seven days after the hospital discharge and one death (0,9%) due to systemic inflammatory response syndrome (SIRS).Conclusion: This study demonstrates the coverage of pathologies that are possible to be approached by videoassisted cardiac surgery with cardiopulmonary bypass being a safe and effective procedure with low morbimortality. Minimally invasive video-assisted cardiac surgery is already a reality in Brazil, demonstrating excellent aesthetic and functional results. Rev Bras Cir Cardiovasc 2009; 24(3): 318-326 and transesophageal echocardiogram, ultrasound of the carotid arteries, abdominal, iliac and femoral arteries. In patients with suspicion of some obstruction of peripheral arteries, angiotomography of the thoracoabdominal aorta was requested. Special care was taken at the time of cardiac catheterization, avoiding puncturing the femoral vessels, giving preference to puncture of the radial artery and complete aortography was performed during the exam. After the first 40 cases, we included patients with an ejection fraction below 55%, emergencies, reoperations and obese patients.The age ranged from 18 to 68 years, and 57 patients were female (55.8%).

POFFO, R ET AL -Minimally invasive video-assisted atrial septal defect correction and myocardial revascularization Rev Bras Cir Cardiovasc 2009; 24(4): 586-589 thread (Monocryl®). The other openings were closed using simple 5-0 nylon sutures. The dressings were prepared using micropore®.

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Objective:To evaluate the short and medium-term outcomes of patients undergoing robotic-assisted minimally invasive cardiac surgery.Methods:From March 2010 to March 2013, 21 patients underwent robotic-assisted cardiac surgery. The procedures performed were: mitral valve repair, mitral valve replacement, surgical correction of atrial fibrillation, surgical correction of atrial septal defect, intracardiac tumor resection, totally endoscopic coronary artery bypass surgery and pericardiectomy.Results:The mean age was 48.39±18.05 years. The mean cardiopulmonary bypass time was 151.7±99.97 minutes, and the mean aortic cross-clamp time was 109.94±81.34 minutes. The mean duration of intubation was 7.52±15.2 hours, and 16 (76.2%) patients were extubated in the operating room immediately after the procedure. The mean length of intensive care unit stay was 1.67±1.46 days. There were no conversions to sternotomy. There was no in-hospital death or deaths during the medium-term follow-up. Patients mean follow up time was 684±346 days, ranging from 28 to 1096 days.Conclusion:Robotic-assisted cardiac surgery proved to be feasible, safe and effective and can be applied in the correction of various intra and extracardiac pathologies.