<b>Video-Assisted Minithoracotomy Approach:</b>
 Technical Developments Towards Totally Endoscopic Sutureless Aortic Valve Replacement

Vola, Marco; Campisi, Salvatore; Anselmi, Amédéo; Faure, Michael; Fuzellier, Jean‐François; Gerbay, Antoine

doi:10.1111/jocs.12368

Cited by 12 publications

(7 citation statements)

References 6 publications

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“…Moreover, with the rapid popularization of some specialized centers, MICS has now become the standard method of cardiac surgery [ 14 , 16 ]. Previous studies have reported that MICS is used in almost all types of cardiac surgery, including mitral valve surgery [ 23 ], ASD repair [ 20 , 24 ], VSD repair [ 25 ], AF ablation [ 26 ], CABG [ 22 , 27 ], and myxoma dissection [ 28 ]. Notably, results of randomized clinical trials (RCTs) and meta-analyzes [ 23 ] have clearly proven that MICS is a safe, efficacious, and repeatable alternative to traditional surgical procedures.…”

Section: Discussionmentioning

confidence: 99%

Minimally Invasive Cardiac Surgery in China: Multi-Center Experience

et al. 2018

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BackgroundTo the best of our knowledge, there is no nationwide data available on the development of minimally invasive cardiac surgery (MICS) in China. The purpose of this study was to report the results of MICS in 6 experienced centers in China.Material/MethodsFrom September 2014 to July 2016, 1241 patients with cardiac conditions who underwent MICS procedures were randomly enrolled in 6 centers in China, and those patients were randomly selected for inclusion in this study. The MICS procedures were defined as any cardiac surgery performed through a less invasive incision, rather than a complete median sternotomy, mainly including mini-incision surgery (400, 32.2%), video-assisted approach (265, 21.3%), completely thoracoscopic approach without robotic assistance (504, 40.6%), and robotic procedure (55, 4.4%).ResultsThe 5 most common in-hospital complications were respiratory failure (28, 2.3%), reoperation for all reasons (19, 1.5%), renal failure (11, 0.9%), heart failure (9, 0.7%), and stroke (6, 0.5%). The multivariate logistic regression analysis results showed that cardiopulmonary bypass (CPB) time (P=0.033), aortic cross-clamp time (P=0.003), cannulation approach (P=0.010), and left ventricular ejection fraction (LVEF) (P=0.003) at baseline were all significant risk factors of any in-hospital complication of MICS procedures.ConclusionsFrom our experience, minimally invasive cardiac approaches are safe and reproducible, with acceptable CPB and aortic cross-clamp time duration and low mortality.

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Section: Discussionmentioning

confidence: 99%

Minimally Invasive Cardiac Surgery in China: Multi-Center Experience

et al. 2018

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“…Of 250 potentially relevant articles screened initially, 11 single-arm studies [7][8][9][10][11][12][13][14][15][16][17][18][19] of sutureless/rapid-deployment AVR reporting early mortality and/or overall survival were identified and included (►Table 1). We excluded 18 studies [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] enrolling <50 patients and 6 studies [38][39][40][41][42][43] (►Table 2) duplicating patients enrolled in other studies. In total, our meta-analysis included data on 2,066 patients undergoing sutureless/rapid-deployment AVR.…”

Section: Resultsmentioning

confidence: 99%

A Meta-Analysis of Sutureless or Rapid-Deployment Aortic Valve Replacement

Takagi

Umemoto

2015

Thorac cardiovasc Surg

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Objective To summarize the safety of sutureless or rapid-deployment aortic valve replacement (AVR), we performed a systematic review and meta-analysis of single-arm studies. Methods MEDLINE and EMBASE were searched through December 2014. Studies considered for inclusion met the following criteria: the design was a single-arm study enrolling ≥50 participants; the study population consisted of patients undergoing sutureless/rapid-deployment AVR; and main outcomes included early (in-hospital or 30-day) mortality and/or overall survival. Results Of 250 potentially relevant articles screened initially, 11 eligible studies enrolling a total of 2,066 patients were identified and included. The Enable, Intuity, and Perceval bioprostheses were used in three, two, and six studies, respectively. Mean age of patients was 77.6 years, and 56.9% of patients were women. Mean logistic European System for Cardiac Operative Risk Evaluation I and II were 10.5 and 7.4%, respectively. Aortic cross-clamp times in overall patients, patients undergoing isolated AVR, those undergoing AVR with any concomitant procedures, and those undergoing AVR with coronary artery bypass grafting were 44.7, 41.9, 56.2, and 51.3 minutes, respectively. Arithmetic mean of early mortality was 2.6%, and fixed-effects combined early mortality was 3.2% (95% confidence interval, 2.5-4.2%). Arithmetic mean of 1-year survival was 89.7%, and fixed-effects combined 1-year mortality was 10.4% (9.0-12.1%). Conclusion Sutureless/rapid-deployment AVR is feasible and safe with approximate 3 and 10% of early and 1-year mortality, respectively. Large-size randomized controlled trials, however, are needed to determine whether sutureless/rapid-deployment AVR improves mortality compared with conventional AVR.

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“…Initial insights from this simulation would tend to support the idea of making the incision as superior and lateral as possible. Such an incision would of course preclude direct visualization and favor a video-assisted approach as described by Vola 13 et al Using a 30 o scope may also help avoid the increased difficulty with visualization of the noncoronary aspect of the annulus, which may otherwise be associated with making the chestwall incision too lateral. As reported by Ito et al on their experience in the infra-axillary approach, long shafted instruments would compensate for the longer intrathoracic distances.…”

Section: Discussionmentioning

confidence: 99%

Simulation of a Right Anterior Thoracotomy Access for Aortic Valve Replacement Using a 3D Printed Model

Wamala¹,

Brüning

Dittmann

et al. 2019

Innovations�(Phila)

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Objective The right anterior lateral thoracotomy (RALT) approach for aortic valve replacement provides excellent outcomes in expert hands while avoiding sternal disruption. It, however, remains a technically demanding niche operation. Instrument trajectories via this access are influenced by patient anatomy, the intercostal space chosen, and surgical retraction maneuvers. Methods To simulate the typical surgical maneuvers, on an anatomically accurate model, and to measure the instrument trajectories, we generated a 3-dimensional (3D) printed model of the heart and chest cavity. A simulated approach to the base of the right coronary sinus via the medial-second intercostal, the lateral-second intercostal, or third intercostal space was made. Keeping the instrument in place, 3D scans of the models and geometrical measurements of the instrument trajectories were performed. Results The 3D scans of the 3D printed model showed a high fidelity when compared to the original computed tomographic scan image geometry (mean deviation of 1.26 ± 1.27mm). The instrument intrathoracic distance was 75 mm via the medial-second, 115 mm via the lateral-second, and 80 mm via the third intercostal space. The 3D angulation of the instrument to the incision was 33.77o, 55.93o, and 38.4o respectively. The distance of the instrument to the lateral margin was 12, 26, and 5 mm respectively. The cranial margin of the incision was always a limiting margin for the instrument. Conclusions Three-dimensional printing and 3D scanning facilitated a realistic simulation of the instrument trajectory during RALT approach. The lateral-second intercostal approach showed the most favorable approach angle and distance from the lateral margin, although it also had the longest intrathoracic distance.

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Video-Assisted Minithoracotomy Approach: Technical Developments Towards Totally Endoscopic Sutureless Aortic Valve Replacement

Cited by 12 publications

References 6 publications

Minimally Invasive Cardiac Surgery in China: Multi-Center Experience

Minimally Invasive Cardiac Surgery in China: Multi-Center Experience

A Meta-Analysis of Sutureless or Rapid-Deployment Aortic Valve Replacement

Simulation of a Right Anterior Thoracotomy Access for Aortic Valve Replacement Using a 3D Printed Model

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