Minimally invasive cardiac surgery—a Fad or the Future?

Ali, Jason M.; Abu‐Omar, Yasir

doi:10.21037/jtd-2020-mics-12

Cited by 4 publications

(5 citation statements)

References 19 publications

(5 reference statements)

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“…A successful MICS programme requires a multidisciplinary approach, requiring involvement from anaesthesiologists, cardiac surgeons, perfusionists, scrub nurses, etc. 21 Myocardial protection plays an essential part in MICS. 4 An ideal cardioplegia solution should minimise myocardial damage, haemodilution, the need for re-dosing, the incidence of arrhythmia on releasing the AXC and cost effective.…”

Section: Discussionmentioning

confidence: 99%

“…26 These were promising because one of the major barriers for MICS is the costs associated with the new perfusion and surgical equipment and instruments needed. 21 Savings from the cardioplegia solution can cover the cost for the new equipment. Study by Zanobini and colleagues suggested the combination of minimally invasive approach with CS significantly preserved right ventricular function post-operatively when compared with MS approach.…”

Section: Discussionmentioning

confidence: 99%

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Network meta-analysis comparing blood cardioplegia, Del Nido cardioplegia and custodiol cardioplegia in minimally invasive cardiac surgery

Chan

Butt

et al. 2022

Perfusion

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Introduction Minimally invasive cardiac surgery has been evolving, with the intention of reducing surgical trauma, improve cosmesis and patient satisfaction. Single dose, crystalloid cardioplegia such as Del Nido cardioplegia and Custoidol solution have been increasingly used to reduce the interruption from repeating cardioplegia dosing to minimise the cardiopulmonary bypass and cross clamp time. However, the best cardioplegia for myocardial protection in adult minimally invasive cardiac surgery remains controversial. We aimed to conduct a meta-analysis to analyse the current evidence in the literature. Method A systematic review and meta-analysis was performed following the updated 2020 PRISMA guideline. Articles published in the five major electronic databases up 1st of April 2021 were identified and reviewed. The primary outcome was in-hospital or 30-day mortality. Traditional pairwise and Bayesian network meta-analyses were conducted. Results Nine articles were included in this study. The use of Del Nido cardioplegia was associated with a lower volume of cardioplegia used (Del Nido vs Blood, 1105.62 mL+/-123.47 vs 2569.46 mL+/-1515.52, p<0.001), cardiopulmonary bypass (Del Nido vs Custoidol vs Blood: 91.67+/−14.78 vs 138.05 +/− 21.30 vs 119.38+/−26.91 minutes, p<0.001) and cross-clamp time (Del Nido vs Custoidol vs Blood: 74.99+/−18.55 vs 82.01 +/− 17.28 vs 93.66+/−8.88 minutes, p < 0.001). No differences were observed in the incidence of in-hospital/30-day mortality rate, new onset of atrial fibrillation and stroke. Ranking analysis showed the Custoidol solution has the highest probability to be the first ranked cardioplegia. Conclusion No differences were found between blood and crystalloid cardioplegia in adult minimally invasive cardiac surgery in several clinical outcomes. The cardioplegia of choice in minimally invasive cardiac surgery remains the surgeons’ decision and preference.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Network meta-analysis comparing blood cardioplegia, Del Nido cardioplegia and custodiol cardioplegia in minimally invasive cardiac surgery

Chan

Butt

et al. 2022

Perfusion

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“…The American Heart Association defined "minimally invasive" as smaller sternotomy or non-sternotomy strategies aided by robotic or video-assisted technologies [22], and a variety of approaches have been described. Access route is a minor component of invasiveness within cardiac surgery, with cardiopulmonary bypass (CPB), aortic cross clamping, cardioplegic arrest and opening of cardiac chambers contributing more to the invasiveness and risk of complications of the procedure, beyond that of the incision [23]. For the surgical treatment of ASD, minimal-access approaches include partial or mini-sternotomy, right anterolateral thoracotomy, right oblique sub-axillary incision, right vertical sub-axillary incision, right posterior mini-thoracotomy, video-assisted thoracoscopy (VATS)/endoscopic and robotic approaches, with peripheral cannulation for cardiopulmonary bypass.…”

Section: Surgical Closurementioning

confidence: 99%

Minimal-Access Atrial Septal Defect (ASD) Closure

Hardman

Zacharias

2023

JCDD

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Progress towards the development and adoption of minimally invasive techniques in cardiac surgery has been slower than that seen in other surgical specialties. Congenital heart disease (CHD) patients represent an important population within cardiac disease, of which atrial septal defect (ASD) is one of the most common diagnoses. Management of ASD encompasses a range of minimal-access and minimally invasive approaches, including transcatheter device closure, mini-sternotomy, thoracotomy, video-assisted, endoscopic, and robotic approaches. In this article, we will discuss the pathophysiology of ASD, along with diagnosis, management, and indications for intervention. We will review the current evidence supporting minimally invasive and minimal-access surgical ASD closure in the adult and paediatric patient, highlighting peri-operative considerations and areas for further research.

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“…Lately, minimally invasive procedures in cardiac surgery (MICS) are gaining popularity and this poses certain challenges for anesthesiology practice [1]. Minimally invasive direct coronary artery bypass (MIDCAB) being commonly applied subtype of MICS where revascularization takes place through conjunction of the left internal thoracic artery (ITA) and left anterior descending artery, nowadays are implemented worldwide more often [2].…”

Section: Introductionmentioning

confidence: 99%

Analysis of the effectiveness of intrapleural analgesia after minimally invasive coronary artery bypass grafting on a beating heart

Dossov,

Seitenov,

Babashev

et al. 2024

J CLIN MED KAZ

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Purpose: To determine the effectiveness of intrapleural analgesia (IPA) for pain relief after minimally invasive coronary artery bypass surgery on a beating heart. Methods: We prospectively studied 35 patients who underwent coronary artery bypass grafting on a beating heart through a mini thoracotomy access on the left. Patients were divided into two groups: group I received IPA with a catheter (n=16) and group II patients were not introduced intrapleural analgesia (n=19). Postoperative pain was assessed according to the visual analogue scale (VAS), consumption of analgesics, extubation time, arterial blood gas parameters. Adequacy of respiration and lung ventilation were estimated by electrical impedance tomography. Results: Extubation time after surgery did not differ in both groups. Arterial oxygen partial pressure was higher (p<0.05) in the first group (160.82±46.98) compared to the second group (111.42±49.26). Regarding the EIT in the quadrant mode, distribution of tidal volume was better in the first group (p<0.05) in the 2nd, 3rd quadrant and in the layer mode, the second layer of the first group showed better results compared to the same layer of the second group. After extubation, average pain score according to VAS was four points for the first group and six points for the second group. On the 1st and 2nd day pain scores were the same in both groups. Postoperative analgesia by promedol was required only for 1 patient (6.25%) from the first group, and 14 patients from the second group (73.7%). Additionally, tramadol was administered to 43.5% (7 patients) of the first group and 26.3% (5 patients) of the second group. Conclusion: IPA can be used as one of the effective treatments for postoperative pain in minimally invasive coronary artery bypass surgeries. IPA promotes less use of opioids. An improvement in respiration was observed with reduction in postoperative pain.

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Minimally invasive cardiac surgery—a Fad or the Future?

Cited by 4 publications

References 19 publications

Network meta-analysis comparing blood cardioplegia, Del Nido cardioplegia and custodiol cardioplegia in minimally invasive cardiac surgery

Network meta-analysis comparing blood cardioplegia, Del Nido cardioplegia and custodiol cardioplegia in minimally invasive cardiac surgery

Minimal-Access Atrial Septal Defect (ASD) Closure

Analysis of the effectiveness of intrapleural analgesia after minimally invasive coronary artery bypass grafting on a beating heart

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