Minimally Invasive Access Aortic Arch Surgery

Goebel, Nora; Bonte, Daniel; Salehi-Gilani, Schahriar; Nagib, Ragi; Ursulescu, Adrian; Franke, Ulrich

doi:10.1097/imi.0000000000000390

Cited by 19 publications

(16 citation statements)

References 15 publications

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“…Interestingly, minimally invasive procedures via partial upper sternotomy might decrease bleeding complications as reported by centres with expertise in this approach. 24 Also, consistent with our results, Liu and colleagues stated that prolonged cross-clamp time and administration of RBC may lead to adverse outcome. 26 Furthermore, duration of ventilation time differed significantly among the three groups in favour of less invasive approaches with a trend toward longer ICU stay in the total arch replacement group.…”

Section: Discussionsupporting

confidence: 91%

“…Further, Goebel and colleagues reported on minimally invasive aortic surgery via partial upper sternotomy with no major cerebrovascular events. 24 However this evidence should be confirmed by further investigations due to the relatively small patient cohort analysed. The importance of stroke was also highlighted by Liu and colleagues who found that stroke was an independent predictor for adverse outcome.…”

Section: Discussionmentioning

confidence: 83%

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Impact of ascending aortic, hemiarch and arch repair on early and long-term outcomes in patients with Stanford A acute aortic dissection

Merkle

Sabashnikov

Deppe

et al. 2018

Therapeutic Advances in Cardiovascular Disease

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Background: Stanford A acute aortic dissection (AAD) is a life-threatening emergency associated with major morbidity and mortality. The aim of this study was to compare outcomes of three different surgical approaches in patients with Stanford A AAD. Methods: From January 2006 to March 2015 a total of 240 consecutive patients with diagnosed Stanford A AAD underwent elective, isolated surgical aortic repair in our centre. Patients were divided into three groups according to the extent of surgical repair: isolated replacement of the ascending aorta, hemiarch replacement and total arch replacement. Patients were followed up for up to 9 years. After univariate analysis multinomial logistic regression was performed for subgroup analysis. Baseline characteristics and endpoints as well as long-term survival were analysed. Results: There were no statistically significant differences among the three groups in terms of demographics and preoperative baseline and clinical characteristics. Incidence of in-hospital stroke (p = 0.034), need for reopening due to bleeding (p = 0.031) and in-hospital mortality (p = 0.017) increased significantly with the extent of the surgical approach. There was no statistical difference in terms of long-term survival (p = 0.166) among the three groups. Applying multinomial logistic regression for subgroup analysis significantly higher odds for stroke (p = 0.023), reopening for bleeding (p = 0.010) and in-hospital mortality (p = 0.009) for the arch surgery group in comparison to the ascending aorta surgery group as well as significantly higher odds for stroke (p = 0.029) for the total arch surgery group in comparison to the hemiarch surgery group were identified. Conclusions: With Stanford A AAD the incidence of perioperative complications increased significantly with the extent of the surgical approach. Subgroup analysis and long-term follow up in patients undergoing isolated ascending or hemiarch surgery showed a lower incidence of cerebrovascular events compared with surgery for total arch replacement.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 83%

Impact of ascending aortic, hemiarch and arch repair on early and long-term outcomes in patients with Stanford A acute aortic dissection

Merkle

Sabashnikov

Deppe

et al. 2018

Therapeutic Advances in Cardiovascular Disease

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“…Although aortic arch surgery using a ministernotomy is seldom performed, recent studies suggest its feasibility and safety. 3,10,11 Access to the supra-aortic branches is straightforward with an upper ministernotomy, as the ascending aorta and root terminate in the third or fourth intercostal space, and visualization of the heart is unnecessary. Strategically placed traction sutures facilitate pericardial retraction for aorta elevation and exposure.…”

Section: Commentmentioning

confidence: 99%

“…1,2 Interest in minimally invasive aortic surgery has been tempered by concerns about adequate procedural exposure and safety. 3 Several studies have reported the feasibility of stent grafting as a purely endovascular approach, or as part of a hybrid approach, for treating arch pathology. [4][5][6][7] Hybrid zone 0 stent grafting involves surgical or endovascular debranching of arch vessels to the proximal native ascending aorta with subsequent stent grafting from the ascending aorta through the arch and descending segments.…”

Section: Introductionmentioning

confidence: 99%

Hybrid Aortic Arch Repair Using a Ministernotomy

Shah

Орлов

Meisner

et al. 2019

Vasc Endovascular Surg

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Hybrid thoracic endovascular aortic repair with surgical arch debranching is an accepted method for total arch reconstruction. Although off-pump arch debranching is increasingly used as a prophylactic adjunct to endovascular arch repair extending into landing zone 0, this technique is seldom performed with a ministernotomy due to a steep learning curve among surgeons. Herein, we report our standard technique for off-pump hybrid total aortic arch repair using a ministernotomy.

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“…M inimally invasive cardiac surgery (MICS) is here to stay, and more complex cardiac surgical procedures are performed through small incisions. [1][2][3] As a result, remote cannulation for the required cardiopulmonary bypass (CPB) is increasing. The preferred site for venous cannulation in this setting is the common femoral vein on either side, which by definition only accept significantly smaller venous cannulas than those traditionally used for central cannulation in similar patients.…”

mentioning

confidence: 99%

Clinical Experience in Minimally Invasive Cardiac Surgery with Virtually Wall-Less Venous Cannulas

Ferrari

Segesser

Berdajs

et al. 2018

Innovations�(Phila)

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Objective Inadequate peripheral venous drainage during minimally invasive cardiac surgery (MICS) is a challenge and cannot always be solved with increased vacuum or increased centrifugal pump speed. The present study was designed to assess the benefit of virtually wall-less transfemoral venous cannulas during MICS. Methods Transfemoral venous cannulation with virtually wall-less cannulas (3/8″ 24F 530–630-mm ST) was performed in 10 consecutive patients (59 ± 10 years, 8 males, 2 females) undergoing MICS for mitral (6), aortic (3), and other (4) procedures (combinations possible). Before transfemoral insertion of wall-less cannulas, a guidewire was positioned in the superior vena cava under echocardiographic control. The wall-less cannula was then fed over the wire and connected to a minimal extracorporeal system. Vacuum assist was used to reach a target flow of 2.4 l/min per m2 with augmented venous drainage at less than −80 mm Hg. Results Wall-less venous cannulas measuring either 630 mm (n = 8) in length or 530 mm (n = 2) were successfully implanted in all patients. For a body size of 173 ± 11 cm and a body weight of 78 ± 26 kg, the calculated body surface area was 1.94 ± 0.32 m2. As a result, the estimated target flow was 4.66 ± 0.78 l/min, whereas the achieved flow accounted for 4.98 ± 0.69 l/min (107% of target) at a vacuum level of 21.3 ± 16.4 mm Hg. Excellent exposure and “dry” intracardiac surgical field resulted. Conclusions The performance of virtually wall-less venous cannulas designed for augmented peripheral venous drainage was tested in MICS and provided excellent flows at minimal vacuum levels, confirming an increased performance over traditional thin wall cannulas. Superior results can be expected for routine use.

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Minimally Invasive Access Aortic Arch Surgery

Cited by 19 publications

References 15 publications

Impact of ascending aortic, hemiarch and arch repair on early and long-term outcomes in patients with Stanford A acute aortic dissection

Impact of ascending aortic, hemiarch and arch repair on early and long-term outcomes in patients with Stanford A acute aortic dissection

Hybrid Aortic Arch Repair Using a Ministernotomy

Clinical Experience in Minimally Invasive Cardiac Surgery with Virtually Wall-Less Venous Cannulas

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