Direct Cannulation in Minimally Invasive Cardiac Surgery With Limited Resources

Abstract

With increasing patient interest in minimally invasive procedures, it is more important than ever for surgeons to be current on the most common minimally invasive techniques in cardiac surgery. As minimally invasive cardiac surgery has evolved, the strategies and approaches to cardiopulmonary bypass access have evolved. Peripheral cannulation is convenient but carries a risk of retrograde dissection, embolization, stroke, and ipsilateral limb ischemia, whereas central aortic cannulation has the advantage of antegrade flow. We report our experience with direct arterial and venous cannulation through a thoracotomy approach without compromising the results. From January 2017 to December 2018, 140 consecutive patients were studied. Mean age was 26 ± 18 years (range, 11 months to 83 years), with 46 patients (32.8%) younger than 12 years and 12 patients weighing less than 10 kg. Spectrum of procedures include atrial septal defect closure (53%), mitral valve repair (14%), ventricular septal defect closure (9%), aortic valve replacement (10%), mitral valve replacement (6%), repair of partial anomalous pulmonary venous drainage (9%), myxoma excision (1%), and ventricular septal defect closure with pulmonary valvotomy (1%). None of the patients was converted from a minimally invasive to standard median sternotomy. One patient with ventricular septal defect died due to pulmonary hypertensive crises. No patient required reexploration for bleeding, and none had stroke or renal failure. There were no myocardial infarctions or aortic dissections. In our experience this approach is a reliable platform for a variety of minimally invasive cardiac surgical procedures and has resulted in low complication rates. The technique can be applied safely to both pediatric and adult populations. Also, it is very cost-effective because regular instruments and cannulas are used.