Minimally invasive and maximally safe approach to cardiac surgery

Abstract

Background. Minimally invasive approaches in cardiac surgery have been introduced in an attempt to limit post operative pain, allow prompt recovery, and reduce the cosmetic impact of the scar.We describe a surgical technique of limited skin incision with complete median sternotomy.Patients & Methods. A comparative study was performed using two groups of 35 patients each in which a minimally invasive incision (Group I) was compared to a routine incision (Group II). Surgical procedures included atrial septal defect closure, mitral, aortic and tricuspid valve surgery.Results. Incision length ranged from 6.9cm to 7.5 cm (mean 7.1 _+ 0.2 cm) in Group I and from 16.5cm to 21cm (mean 19.4 _+ 1.2 cm) in Group lI (Group I vs Group II, p<0.01). The operating time, cardiopulmonary bypass time, aortic cross clamp time were not significantly different in both the groups. Similarly, post-operative drainage was also not significantly different. The mean hospital stay of patients in Group I was 5.7 _+ 1.0 days (range 5-9 days) and 7.3 +_ 1.1 days (range 6-9 days) in Group II (Group I vs Group II, p<0.01). There was no operative mortality or morbidity.Conclusion. This technique provides full, safe and easy access to all cardiac structures with acceptable cosmetic results. No special instruments are required. (Ind J Cardiovase Surg. 2000; 16: 90-92)

What is minimal in “minimally invasive cardiac surgery”?

“…This is also combined with an additional groin incision for inevitable cannulation of the femoral vessels. [2][3][4][5] It involves special expensive instruments including Chitwood clamps, retractors, and long specially designed needle holders and hooks. It also involves the likelihood of expensive imaging to assess feasibility, such as magnetic resonance imaging and computed tomography, and it requires expensive cannulation techniques and cannulae.…”