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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