vs. LICS options vs. catheter based( TAVR, TEVAR, etc.) options based on current guidelines, patient pathology and functional status, operator experience and outcomes, cost and after joint discussion with the cardiovascular( surgeon-cardiologist) team.
Table 3
Small incision approaches( target) 6 cm
1. Mini Sternotomy, upper( Aortic and mitral valves, ascending aorta repair)
2. Mini-sternotomy, lower( mitral, tricuspid, ASD, LAD bypass)
3. Mini thoracotomy, right( Mitral and tricuspid, MAZE, ASD, tumors, other)
4. Mini thoracotomy, Left( coronary surgery, LV surgery, TAVR, pacing leads)
5. Sub-xyphoid( arrhythmia surgery)
We have been able to apply over an 80 percent“ small incision” procedural rate to isolated valve problems. Patient’ s valve problems are discussed weekly in a multidisciplinary conference to determine the indication for surgery, the timing and expected outcomes. We discuss less than optimal outcomes as well, to learn from them. This selective and team approach to cardiac pathology has been very gratifying for all involved and have allowed us excellent outcomes. Good for patients and cardiovascular doctors alike!
In summary and as an update, there is still a continuous trend over less invasiveness in cardiac surgery and a tsunami of new technology that is out there for adoption and cautious use. For the most, data supports the trend. So, is LICS here to stay? Despite the slow adoption, yes, it is in my view. But these procedures are not only for the surgeons and centers with a proven interest and experience, but also mainly for selected patients with realistic expectations.
FEATURE
1. Iribarne A, Easterwood R, Chan EYH, et al. The golden age of minimally invasive cardiothoracic surgery: current and future perspectives. Future Cardiol. 2011 May: 333-346.
2. Murphy GJ, Reeves BC, Rogers CA, et al. Increased mortality, postoperative morbidity and cost after red blood cell transfusion in patients having cardiac surgery. Circulation 2007; 116:2544-52.
3. Pagni, S. Less invasive cardiac surgery. Is it here to stay? Louisville Medicine, 2012( March), 9-11.
4. Puskas JD, Thourani VH, Kilgo P, Cooper W, Vassiliadis T, Vega JD, et al. Off pump coronary artery bypass disproportionally benefits high risk patients. Ann Thorac Surg 2009; 88:1142-7.
5. Puskas J, Cheng D, Knight J, Angelini G, DeCannier D, Diegeler A, et al. Off pump versus conventional coronary artery bypass grafting: a meta-analysis and consensus statement from 2004 ISMICS consensus conference. Innovations 2005( 1) 3-27.
6. Shroyer AL, Hattler B, Wagner TH, Baltz JH, Collins JF, Carr BM, et al( ROOBY Study Group). Comparing off pump and on pump outcomes and costs for diabetic cardiac surgery patients. Ann Thorac Surg 2014; 98:38-45.
7. Seeburger J, Borger MA, Falk V, Kuntze T, Czesla M, Walther T, Doll N, Mohr FW. Minimally invasive mitral valve repair for mitral regurgitation: results of 1339 consecutive patients. Eur J Cardiothorac Surg 2008; 34:760-765.
8. Murphy DA, Miller JS, Langford DA, Snyder AB. Endoscopic robotic mitral valve surgery. J Thorac Cardiovasc Surg 2006; 132( 4): 776-81.
Dr. Pagni is a Cardiovascular Surgeon with Baptist Cardiac Surgery, Center for Less Invasive Cardiac Surgery at Baptist Health Louisville and Director, Cardiac Surgery Program at Baptist Health Floyd, New Albany, IN.
Acronyms:
MICS: Minimally invasive cardiac surgery LICS: less invasive cardiac surgery CBP: Cardiopulmonary bypass TEVAR: Thoracic endovascular aneurysm repair TAVR: Trans-aortic aortic valve replacement CV: Cardiovascular
REFERENCES:
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