Facile Minimally Invasive Cardiac Surgery via Ministernotomy

Gundry, Steven R.; Shattuck, O.Howard; Razzouk, Anees J.; Rio, M. J. Del; Sardari, Frederic; Bailey, Leonard L.

doi:10.1016/s0003-4975(98)00064-2

Cited by 241 publications

(113 citation statements)

References 2 publications

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“…In the late 1990s, a new procedure termed 'minimally invasive mitral valve surgery' (MIMVS) was being suggested (Cosgrove III et al, 1998;Gundry et al, 1998;Byrne et al, 2000;Gillinov et al, 2000). This procedure can minimize surgical trauma, resulting in reduced operative mortality, less pain, improved quality of life, and better cosmetic results by reducing the size of the incision, particularly for young females and older people (Walther et al, 1999;Soltesz and Cohn, 2007).…”

Section: Introductionmentioning

confidence: 99%

Anterolateral minithoracotomy versus median sternotomy for mitral valve disease: a meta-analysis

Ding

Jiang

Tao

et al. 2014

J. Zhejiang Univ. Sci. B

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Abstract:Objective: Mitral valve disease tends to be treated with anterolateral minithoracotomy (ALMT) rather than median sternotomy (MS), as ALMT uses progressively smaller incisions to promote better cosmetic outcomes. This meta-analysis quantifies the effects of ALMT on surgical parameters and post-operative outcomes compared with MS. Methods: One randomized controlled study and four case-control studies, published in English from January 1996 to January 2013, were identified and evaluated. Results: ALMT showed a significantly longer cardiopulmonary bypass time (P=0.001) and aortic cross-clamp time (P=0.05) compared with MS. However, the benefits of ALMT were evident as demonstrated by a shorter length of hospital stay (P<0.00001). According to operative complications, the onset of new arrhythmias following ALMT decreased significantly as compared with MS (P=0.05); however, the incidence of peri-operative mortality (P=0.62), re-operation for bleeding (P=0.37), neurologic events (P=0.77), myocardial infarction (P=0.84), gastrointestinal complications (P=0.89), and renal insufficiency (P=0.67) were similar to these of MS. Long-term follow-up data were also examined, and revealed equivalent survival and freedom from mitral valve events. Conclusions: Current clinical data suggest that ALMT is a safe and effective alternative to the conventional approach and is associated with better short-term outcomes and a trend towards longer survival.

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Section: Introductionmentioning

confidence: 99%

Anterolateral minithoracotomy versus median sternotomy for mitral valve disease: a meta-analysis

Ding

Jiang

Tao

et al. 2014

J. Zhejiang Univ. Sci. B

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“…Division of the upper half of the sternum gives the surgeon direct access to the ascending aorta and to the right atrial appendix, enabling its direct cannulation. In 1996, GUNDRY et al [1] proposed hemi-sternotomies, then denominated as ministernotomy, as the preferred access for the correction of congenital heart disease and isolated valve operations in adults. They considered this approach advantageous allowing utilization of the regular equipment used in traditional surgeries as it does not need cannulation of the femoral veins, as well as enabling the rapid conversion to total sternotomy.…”

Section: Commentsmentioning

confidence: 99%

“…Thus, inguinal incision used for both venous and arterial femoral access was avoided. A new incision always signifies the risk of further complications [1]. Several surgical teams have been using vacuum venous drainage (with a negative pressure of 50 mmHg in the venous reservoir), which allows the utilization of thinner venous cannulae and reduces the priming volume of the machine by eliminating the necessity of filling the venous lines.…”

Section: Commentsmentioning

confidence: 99%

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Acesso minimamente invasivo para troca da valva aórtica: resultados operatórios imediatos comparativos com a técnica tradicional

Tyszka

Watanabe

Cabral

et al. 2004

Rev Bras Cir Cardiovasc

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Objective: Minimally invasive heart surgeries are approaches used to reduce trauma, to give better cosmetic results and to reduce hospital costs with the same safety as conventional surgery. This study was designed to compare the operative results from patients who underwent minimally invasive aortic valve replacement with those who were submitted to the standard procedure.Method: The operative and immediate postoperative results of 12 consecutive patients who received minimally invasive isolated aortic valve replacements from June 2002 to February 2003 were compared to 12 patients who underwent to traditional approach in the same institution. The minimally invasive access used was superior median hemisternotomy where cardiopulmonary bypass was established through ascending aorta and right atrium cannulation, similar to the traditional technique.Results: The demographics of the patients were similar in both groups. There were no significant differences between aortic clamping time, total bypass time and operating time. The skin incision length was statistically shorter in the minimally invasive group. In the postoperative course, the mechanical ventilation time and the total hospital stay were shorter, but not statistically significant, in the minimally invasive group. The morbidity was the same in two groups.Conclusions: This surgical approach provides adequate exposure of the cardiac structures necessary to perform a safe valve replacement. With the same instruments used in the traditional surgery we can offer the benefits of a less invasive access with the same efficiency as in the conventional approach without adding any risks to our patients. Descriptors

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“…Potential advantages include improved cosmetic results and comfort for the patient as well as shorter hospital stays, which impact on total cost 9 . Approaches that are widely used for the pediatric population include the anterior thoracotomy 5,8,[10][11] and upper or lower minimal access sternotomy [12][13][14] , with or without video assistance. Important factors for the surgeon, especially in congenital heart disease, are adequate exposure for precise intracardiac repair, safe application of cardiopulmonary bypass through a central or peripheral site and adequate myocardial protection.…”

Section: Introductionmentioning

confidence: 99%

Correção de defeitos cardíacos congênitos simples em crianças e adolescentes por meio de minitoracotomias

Silveira¹,

Bosco²,

Leite³

et al. 2007

Arq. Bras. Cardiol.

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SummaryObjective: To evaluate the repair of congenital heart defects through minithoracotomies.Methods: Between January 1998 and March 2005, 98 patients underwent minithoracotomies for simple congenital heart defect repairs at our institution. All patients were female between the ages of 14 months and 16 years (mean 4.6) with weights ranging from 8 to 58 Kg (mean 20). Diagnoses included 78 cases of atrial septal defects (ASD) (six with associated partial anomalous pulmonary venous drainage and four with pulmonary valve stenosis) and 20 cases of perimembranous ventricular septal defects (PVSD). All diagnoses were confirmed with an echocardiogram; therefore, cardiac catheterization was not required. A right submammary minithoracotomy was performed on 10 patients and a minithoracotomy with a partial median sternotomy was performed on 88 patients.Results: All defects were corrected successfully with satisfactory exposure. Cardiopulmonary bypass times ranged from 8 to 30 min (mean 10) and aortic clamping times ranged from 5 to 22 min (mean 12). All patients were extubated in the operating room and hospital stays ranged from 3 to 7 days (mean 5). There were no deaths during the operation or severe postoperative complications. No residual shunts were observed.Conclusions: Our study demonstrated that the minithoracotomy is a safe effective and technically viable alternative to a median sternotomy to correct selected simple congenital heart defects. The advantages of this approach include less trauma, partial or complete preservation of sternum continuity and integrity, and elimination of postoperative deformities such as pectus carinatum. The cosmetic outcome was superior to a median sternotomy.

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Facile Minimally Invasive Cardiac Surgery via Ministernotomy

Cited by 241 publications

References 2 publications

Anterolateral minithoracotomy versus median sternotomy for mitral valve disease: a meta-analysis

Anterolateral minithoracotomy versus median sternotomy for mitral valve disease: a meta-analysis

Acesso minimamente invasivo para troca da valva aórtica: resultados operatórios imediatos comparativos com a técnica tradicional

Correção de defeitos cardíacos congênitos simples em crianças e adolescentes por meio de minitoracotomias

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