Conversion to full sternotomy during minimal-access cardiac surgery: Reasons and results during a 9.5-year experience

Tabata, Minoru; Umakanthan, Ramanan; Khalpey, Zain; Aranki, Sary F.; Couper, Gregory S.; Cohn, Lawrence H.; Shekar, Prem

doi:10.1016/j.jtcvs.2007.01.077

Cited by 55 publications

(40 citation statements)

References 13 publications

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“…In circumstances where adequate exposure cannot be obtained, the minimally invasive surgery may need to be converted to a standard median sternotomy. Although data for double valve surgery are scarce, the conversion rate of minimally invasive surgery to median sternotomy is 1.0-4.0% during single valve operations (24,25). In the present study, even though 9.4% underwent re-operative surgery, adequate exposure was obtained in all patients, and none required conversion to a median sternotomy.…”

Section: Discussioncontrasting

confidence: 42%

Outcomes of minimally invasive double valve surgery

et al. 2017

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Background: Double valve surgery is associated with an increased peri-operative morbidity and mortality.A less invasive right thoracotomy approach may be a viable alternative to median sternotomy surgery in these higher-risk patients. Methods: We retrospectively analyzed the baseline demographics, operative characteristics, and postoperative outcomes of patients who underwent minimally invasive double valve surgery between January 2009 and December 2011 at our institution. Results: The cohort consisted of 117 patients, of which 68 (58.1%) were female. The mean age was 73±11 years, and the mean left ventricular ejection fraction was 52±11%. There were 43 (36.8%) patients with a history of congestive heart failure, 45 (38.5%) with chronic obstructive pulmonary disease, and 5 (4.3%) had a history of chronic kidney disease. The patients underwent primary (90.6%) or re-operative (9.4%) double valve surgery, which consisted of 50 (42.7%) aortic valve replacement and mitral valve repair, 31 (26.5%) mitral and tricuspid valve repair, 18 (15.4%) aortic and mitral valve replacement, 17 (14.5%) mitral valve replacement with tricuspid valve repair, and 1 (0.9%) aortic valve replacement with tricuspid valve repair.Post-operatively, there were 40 (34.2%) cases of prolonged ventilation, 9 (7.7%) acute kidney injury, 6 (5.1%) re-operations for bleeding, 1 (0.9%) cerebrovascular accident, and 15 (12.8%) cases of atrial fibrillation. The mean total hospital length of stay was 12±12 days, with an in-hospital mortality of 2 (1.7%).Conclusions: A minimally invasive right thoracotomy approach to primary or re-operative double valve surgery is feasible, may be utilized with acceptable peri-operative morbidity and mortality.

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Section: Discussioncontrasting

confidence: 42%

Outcomes of minimally invasive double valve surgery

et al. 2017

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“…A retrograde cardioplegia cannula is placed using TEE guidance. However, since we experienced coronary sinus injury in two patients, we recommend that should there be any difficulty in placing a retrograde cardioplegia cannula, the placement should be aborted or deferred until after an elective conversion to a full sternotomy [21]. Ventricular pacing wires are placed on the anterior right ventricular wall.…”

Section: Discussionmentioning

confidence: 99%

“…Ventricular pacing wires are placed on the anterior right ventricular wall. This manipulation should be performed with the empty heart on cardiopulmonary bypass to avoid injury of the right ventricle [21]. The incidence of postoperative bleeding requiring reexploration was 2.5%.…”

Section: Discussionmentioning

confidence: 99%

Early and late outcomes of 1000 minimally invasive aortic valve operations☆

Tabata

Umakanthan

Cohn

et al. 2008

European Journal of Cardio-Thoracic Surgery

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179

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Objective: Minimal access cardiac valve surgery is increasingly utilized. We report our 11-year experience with minimally invasive aortic valve surgery. Methods: From 07/96 to 12/06, 1005 patients underwent minimally invasive aortic valve surgery. Early and late outcomes were analyzed. Results: Median patient age was 68 years (range: 24-95), 179 patients (18%) were 80 years or older, 130 patients (13%) had reoperative aortic valve surgery, 86 (8.4%) had aortic root replacement, 62 (6.1%) had concomitant ascending aortic replacement, and 26 (2.6%) had percutaneous coronary intervention on the day of surgery (hybrid procedure). Operative mortality was 1.9% (19/1005). The incidences of deep sternal wound infection, pneumonia and reoperation for bleeding were 0.5% (5/1005), 1.3% (13/1005) and 2.4% (25/1005), respectively. Median length of stay was 6 days and 733 patients (72%) were discharged home. Actuarial survival was 91% at 5 years and 88% at 10 years. In the subgroup of the elderly (80 years), operative mortality was 1.7% (3/179), median length of stay was 8 days and 66 patients (37%) were discharged home. Actuarial survival at 5 years was 84%. There was a significant decreasing trend in cardiopulmonary bypass time, the incidence of bleeding, and operative mortality over time. Conclusions: Minimal access approaches in aortic valve surgery are safe and feasible with excellent outcomes. Aortic root replacement, ascending aortic replacement, and reoperative surgery can be performed with these approaches. These procedures are particularly well-tolerated in the elderly. #

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“…8, 9 As partial-sternotomy or thoracotomy provides limited exposure to the heart, myocardial protection, deairing, and valve exposure can be more challenging. 10 Previous published studies on mini-AVR have been limited to single high-volume centers. The contemporary outcomes of mini-AVR as it has disseminated to centers with more diverse volume and experience is unknown.…”

Section: Introductionmentioning

confidence: 99%

Minimally invasive aortic valve replacement provides equivalent outcomes at reduced cost compared with conventional aortic valve replacement: A real-world multi-institutional analysis

Ghanta

LaPar

Kern

et al. 2015

The Journal of Thoracic and Cardiovascular Surgery

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Background Several single center studies have reported excellent outcomes with minimally invasive aortic valve replacement (mini-AVR). Although criticized as requiring more operative time and complexity, mini-AVR is increasingly performed. We compared contemporary outcomes and cost of mini-AVR versus conventional AVR in a multi-institutional regional cohort. We hypothesize that mini-AVR provides equivalent outcomes to conventional AVR without increased cost. Methods Patient records for primary isolated AVR (2011–2013) were extracted from a regional, multi-institutional Society of Thoracic Surgeons (STS) database and stratified by conventional versus mini-AVR, performed by either partial sternotomy or right thoracotomy. To compare similar patients, a 1:1 propensity match cohort was performed after adjusting for surgeon, operative year, and STS risk score including age and risk factors (n=289 in each group). Differences in outcomes and cost were analyzed. Results A total of 1,341 patients underwent primary isolated AVR, of which 442 (33%) underwent mini-AVR at 17 hospitals. Mortality, stroke, renal failure and other major complications were equivalent between groups. Mini-AVR was associated with decreased ventilator time (5 vs 6 hours; p=0.04) and decreased blood product transfusion (25% vs 32%; p=0.04). A greater percentage of mini-AVR patients were discharged within 4 days of the operation (15.2% vs 4.8%; p<0.001). Consequently, total hospital costs were lower in the mini-AVR group ($36,348 vs $38,239; p=0.02). Conclusions Mortality and morbidity outcomes of mini-AVR are equivalent to conventional AVR. Mini-AVR is associated with decreased ventilator time, blood product utilization, early discharge, and reduced total hospital cost. In contemporary clinical practice, mini-AVR is safe and cost-effective.

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Conversion to full sternotomy during minimal-access cardiac surgery: Reasons and results during a 9.5-year experience

Cited by 55 publications

References 13 publications

Outcomes of minimally invasive double valve surgery

Outcomes of minimally invasive double valve surgery

Early and late outcomes of 1000 minimally invasive aortic valve operations☆

Minimally invasive aortic valve replacement provides equivalent outcomes at reduced cost compared with conventional aortic valve replacement: A real-world multi-institutional analysis

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