Abstract
Introduction: Minimally invasive approach in cardiac surgery has become an established and common technique in many cardiac surgery centres throughout the world. We report how we safely introduced minimally invasive approach in cardiac surgery in our department and we aim to demonstrate that this approach is feasible in any medium-size cardiac surgical centre. Methods: it consisted of retrospective and descriptive study on 60 patients who underwent minimally invasive mitral valve (45) or aortic valve surgery (15) from January 2017 to Februry 2018. The approach was 3 to 6-cm right thoracotomy through the 4th and 5th intercostal space. The Cor-KnotTM system was used to tie the knots of the prosthesis in case of mitral valve replacement and aortic valve replacement and the ring if mitral valve repair. Results: There was no conversion of thoracotomy to sternotomy. The average duration in ICU was 4.3± 2.3 days and 3.3 ± 1.5 respectively for mitral and aortic valve surgery. Four mitral patients and 1 aortic patient were reoperated for bleeding. No in-hospital death was observed. The postoperative discharge echocardiogram was normal in 95.6% of the mitral valve patients the trans-aortic mean gradient for the aortic valve patients was 16.3 ± 6 mm Hg. The thirty-day mortality was zero. In the majority of the patients, the scar of the thoracotomy were almost unseen. Conclusion: It is possible to safely implement this new approach in any mid-size cardiac centers. The use of modern technology such as 3D video and Cor Knot allows achievement of excellent short term outcomes.
Highlights
Invasive approach in cardiac surgery has become an established and common technique in many cardiac surgery centres throughout the world
The other major contributor to this approach is Jean Francois Obadia (Lyon, France) who adopted transthoracic aortic clamping rather than of intra-aortic balloon of Vanermen.[3]. Another great contributor to minimally invasive approach for aortic valve surgery was Mattia Glauber (Milan, Italy) who described a right straight incision with a mean length of 6–8 cm, through the third intercostal space, which gives a perfect valve exposure and working field to replace the aortic valve without any particular difficulties. 4One constraint of minimally invasive surgery is the need for remote knot tying, which is typically accomplished with the use of a knot pusher
In Auvergne region, France, traditional approach for valve surgery by sternotomy has been performed since 1985.6 The minimally invasive technique started in January 2017 with 3D video assisted approach with Cor Knot for mitral and tricuspid valve surgery
Summary
Invasive approach in cardiac surgery has become an established and common technique in many cardiac surgery centres throughout the world. We report how we safely introduced minimally invasive approach in cardiac surgery in our department and we aim to demonstrate that this approach is feasible in any medium-size cardiac surgical centre. The COR-KNOT technology (LSI SOLUTIONS, Victor, NY USA) was developed to address this unmet need in the field of minimally invasive valve surgery. This device has been widely accepted by cardiac surgeons for the recognized benefits of time savings, simplicity, and reliability.[5] In Auvergne region, France, traditional approach for valve surgery by sternotomy has been performed since 1985.6 The minimally invasive technique started in January 2017 with 3D video assisted approach with Cor Knot for mitral and tricuspid valve surgery. We would show that depending on the curve of learning and modern devices (3D video, Cor-Knot), it is possible to achieve good outcomes
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