The Opportunities and Limitations of Minimally Invasive Cardiac Surgery

Doenst, Torsten; Diab, Mahmoud; Sponholz, Christoph; Bauer, Michael; Färber, Gloria

doi:10.3238/arztebl.2017.0777

Cited by 57 publications

(66 citation statements)

References 60 publications

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“…Though hydrogels have gained tremendous interest as uniquely powerful materials in biomedicine, on‐going challenges hamper their clinical use. Though preformed hydrogels can be customized to support cell transplantation and engraftment, invasive surgical procedures required for physical placement within patients increase risks of infection, complications, pain, patient discomfort, and medical care cost (Doenst, Diab, Sponholz, Bauer, & Färber, ). Injectable hydrogel biomaterials offer distinct advantages for many applications, readily taking the shape of irregular cavities while providing a minimally invasive module of delivery.…”

Section: Introductionmentioning

confidence: 99%

Self‐healing injectable gelatin hydrogels for localized therapeutic cell delivery

Sisso

Boit

DeForest

2020

J Biomedical Materials Res

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Self‐healing injectable hydrogel biomaterials uniquely enable precise therapeutic deposition and deployment at specific bodily locations through versatile and minimally invasive processes that can preserve cargo integrity and cell viability. Despite the distinct advantages that injectable hydrogels offer in tissue engineering and therapeutic delivery, exceptionally few have been created using components naturally present in the cellular niche. In this work, we introduce a shear‐thinning hydrogel based on guest‐host complexation of gelatin. As a biocompatible, biodegradable, and nonimmunogenic biopolymer derived from the most abundant extracellular matrix protein (collagen), gelatin offers great utility as the structural component of biomaterials. Taking advantage of reversible guest‐host interactions between β‐cyclodextrin (CD) and adamantane (AD) on modified gelatins, we report the first strategy to afford a self‐healing material based solely on a functionalized extracellular matrix protein. By varying the initial material formulation, hydrogels were synthesized with variable moduli and shear‐thinability across a broad range. Gels were demonstrated to exhibit shear‐thinning and self‐healing properties, supporting protection of clinically relevant stem‐cell‐derived cardiomyocytes during injection. These materials are expected to expand clinical opportunities in cell delivery for in vivo tissue regeneration.

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Section: Introductionmentioning

confidence: 99%

Self‐healing injectable gelatin hydrogels for localized therapeutic cell delivery

Sisso

Boit

DeForest

2020

J Biomedical Materials Res

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“…Clamp times have always been considered a risk factor for mortality in cardiac surgery . Thus, one may even suspect worse outcomes with this procedure.…”

Section: Discussionmentioning

confidence: 99%

“…Clamp times have always been considered a risk factor for mortality in cardiac surgery. 11 Thus, one may even suspect worse outcomes with this procedure. Although we did not perform a comparison to sternotomy patients in this learning curve analysis (where clamp times of the same surgeons would be substantially shorter), the fact that we achieved an O/E ratio of under 0.3 would not support this concern.…”

Section: Discussionmentioning

confidence: 99%

Minimally‐invasive parasternal aortic valve replacement–A slow learning curve towards improved outcomes

et al. 2020

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Background We report our starting experience with parasternal minimally‐invasive aortic valve replacement. Methods From 7/14 to 8/18, 192 received classic aortic valve surgery using a 5 cm parasternal incision and percutaneous groin cannulation. Patients were selected based on anatomic feasibility judged by preoperative computed tomography‐scan. Except for porcelain aorta, left‐sided aortic location, or endocarditic abscess, there were no exclusions. Results Patients were divided into two groups (first and second half of experience). Demographics were equal. Patients’ mean ejection fraction was 59%, with preoperative stroke (12%), severe chronic obstructive pulmonary disorder (11%), and endocarditis (2%). All cases were elective or urgent. The Euroscore II was 3.37 ± 3.31 in the first and 3.68 ± 3.97 in the second group (n.s.). Biological prostheses were implanted in 90%. Operating times in the first group were just under 3 hours, with bypass times of 129 ± 32 minutes and clamp times of 77 ± 20 minutes. In the second group, these times changed only minimally. There were three conversions to sternotomy in the first, but only one in the second group. Similarly, three patients died in the first and one in the second group. There were fewer complications in the second group regarding revision for bleeding (7 vs 1%), stroke (4 vs 0%) dialysis (3 vs 1%), and pericardial effusions (3 vs 1%). The O/E ratio dropped from 0.93 to 0.28. Conclusions Parasternal minimally‐invasive aortic valve replacement is a feasible technique associated with a slow learning curve but the potential to achieve improved outcomes. Considering the transcatheter alternatives, the relative risk reduction may be worth investigating in future trials.

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“…Minimally invasive techniques to treat isolated cardiac valve disease have gained considerable acceptance within the last two decades due to the accumulating body of evidence suggesting similar outcomes to conventional sternotomy 19‐24 . The additional benefits of reduced pain and enhanced recovery are desirable for many patients which have significant implications in the context of increasing patient‐centred care 25 . Despite the perceived advantages and the constantly expanding aging population requiring more valvular operations, uptake of MIS has been slow.…”

Section: Discussionmentioning

confidence: 99%

Comparison of outcomes between minimally invasive and median sternotomy for double and triple valve surgery: A meta‐analysis

et al. 2020

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Background Limited data exists demonstrating the efficacy of minimally invasive surgery (MIS) compared to median sternotomy (MS) for multiple valvular disease (MVD). This systematic review and meta‐analysis aims to compare operative and peri‐operative outcomes of MIS vs MS in MVD. Methods PubMed, Ovid, and Embase were searched from inception until August 2019 for randomized and observational studies comparing MIS and MS in patients with MVD. Clinical outcomes of intra‐ and postoperative times, reoperation for bleeding and surgical site infection were evaluated. Results Five observational studies comparing 340 MIS vs 414 MS patients were eligible for qualitative and quantitative review. The quality of evidence assessed using the Newcastle‐Ottawa scale was good for all included studies. Meta‐analysis demonstrated increased cardiopulmonary bypass time for MIS patients (weighted mean difference [WMD], 0.487; 95% confidence interval [CI], 0.365‐0.608; P < .0001). Similarly, aortic cross‐clamp time was longer in patients undergoing MIS (WMD, 0.632; 95% CI, 0.509‐0.755; P < .0001). No differences were found in operative mortality, reoperation for bleeding, surgical site infection, or hospital stay. Conclusions MIS for MVD have similar short‐term outcomes compared to MS. This adds value to the use of minimally invasive methods for multivalvular surgery, despite conferring longer operative times. However, the paucity in literature and learning curve associated with MIS warrants further evidence, ideally randomized control trials, to support these findings.

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The Opportunities and Limitations of Minimally Invasive Cardiac Surgery

Abstract: Specialized surgeons and centers can now carry out many cardiac valvular and bypass operations via minithoracotomy rather than sternotomy. According to current evidence, these minimally invasive techniques yield results that are at least as good as classic open-heart surgery.

Cited by 57 publications

References 60 publications

Self‐healing injectable gelatin hydrogels for localized therapeutic cell delivery

Self‐healing injectable gelatin hydrogels for localized therapeutic cell delivery

Minimally‐invasive parasternal aortic valve replacement–A slow learning curve towards improved outcomes

Comparison of outcomes between minimally invasive and median sternotomy for double and triple valve surgery: A meta‐analysis

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