Minimally Invasive Cardiac Surgery: Current Status and Perspective

Abstract

Recently, the minimally invasive approach has become a growing aspect in the field of cardiac surgery with the goal of eliminating cardiopulmonary bypass (CPB) and/or median sternotomy. In coronary bypass surgery, the application of this approach is direct anastomosis, primarily of the left internal thoracic artery to the left descending coronary artery under a beating condition without the use of CPB through a small left thoracotomy minimally invasive direct coronary artery bypass (MIDCAB). In the repair of intracardiac lesions, CPB cannot be excluded, but a small right parasternal incision or small partial sternotomy (ministernotomy) has been applied for congenital defects and mitral and aortic valve lesions. With technological advances in CPB, these approaches may become more popular in the near future.

A new bladder allows kinetic venous augmentation with a roller pump

“…With vacuum augmented venous drainage (VAVD), a vacuum regulator can regulate the negative pressure in the reservoir to achieve a con-trolled emptying of the right heart. 1,2,6 Negative pressure is monitored via a pressure transducer in the venous line. Reportedly, a maximum negative pressure of −80 mmHg is sufficient.…”

“…Augmented venous drainage (AVD) is a technique that overcomes flow limitations by actively aspirating blood from the venous site, and by increasing venous drainage and flow rate. [1][2][3][4][5] AVD also allows a decrease in the inner diameter of the venous line, thereby reducing prime volume, and it allows the use of a smaller cannula, meaning easier insertion, a better surgical view and a smaller surgical incision. Two methods for augmenting drainage are now used clinically, each with advantages and disadvantages: in one, vacuum is applied directly to the hardshell venous reservoir (vacuum augmented venous drainage, VAVD); 6 and, in the other, a pump is connected in the venous line (kinetic augmented venous drainage, KAVD).…”

“…Two methods for augmenting drainage are now used clinically, each with advantages and disadvantages: in one, vacuum is applied directly to the hardshell venous reservoir (vacuum augmented venous drainage, VAVD); 6 and, in the other, a pump is connected in the venous line (kinetic augmented venous drainage, KAVD). [1][2][3][4][5] The former does not allow use of a closed-bag reservoir, while the latter cannot be accomplished with a roller pump. We describe a system that allows kinetic venous augmentation with a closed venous reservoir and a roller pump.…”

Regional Ischemic Preconditioning Enhances Myocardial Performance in Off-Pump Coronary Artery Bypass Grafting

“…7 Surgical procedures on the beating heart require less blood to be transfused and afford shorter hospital stays, lower rates of organ dysfunction (including cerebrovascular complications), fewer hemorrhagic complications, and lower mortality rates in high-risk patients. 8,9 Thus, surgical procedures on the beating heart reduce the cost of surgery. 8 However, a less optimal operative field and limited access may result in incomplete procedures.…”

“…8 However, a less optimal operative field and limited access may result in incomplete procedures. 9 The ischemic period during grafting may cause contractile dysfunction and vascular endothelial injury, and involves a risk of myocardial necrosis. 10 Ischemic preconditioning (IP) is created by a brief period of myocardial ischemia followed by reperfusion, and it increases myocardial tolerance to subsequent long-term ischemic insult.…”