Francesco G Irace1, David Rose2, Riccardo D'Ascoli3, Federica Caldaroni1, Ines Andriani1, Fernando Piscioneri1, Piergiusto Vitulli4, Matteo Piattoli5, Luigi Tritapepe5, Ernesto Greco1. 1. Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological, and Geriatric Sciences, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy. 2. Department of Cardiothoracic, Lancashire Cardiac Centre, Blackpool Victoria Teaching Hospital, Blackpool FY3 8NR, UK. 3. Department of Cardiac Surgery, Ospedale dell'Angelo, Mestre, 30174 Venice, Italy. 4. Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, 04100 Latina, Italy. 5. Department of Anesthesiology and Intensive Care, Sapienza University of Rome, Rome, Italy.
Abstract
BACKGROUND: Minimally invasive and video assisted mitral valve surgery has been used widely since beginning of 20th. Different reduced surgical approaches allowed replacing or repairing a mitral valve sparing sternal incision. Nevertheless the most used strategy has been in the last years the right mini thoracotomy and the extra thoracic cardiopulmonary bypass (CPB). The main goal is avoiding sternal approach for mitral valve procedures and improve postoperative course of the patients. Some postoperative complication likes blood loss, need for transfusion, prolonged intubation and infection has been reduced using this alternative technique. A special advantages has been reported in elderly or high risk patients and in redo cases. METHODS: Several cardiac centres using videoscopy and a revolutionary set up for CPB management and aortic occlusion have adopted the approach. The team approach, including surgeon, anaesthesiologist, nurse, cardiologist and perfusionist, is crucial for a safe and effective realization of this surgical strategy. The proper use of catheters and Seldinger skilfulness, and the guidance of trans-esophageal echocardiography (TEE) during the procedure are two milestones of this technique. A careful and progressive learning curve is required for all the components of the team. In fact some peculiarity likes modified surgical instruments, 3D and Full HD video assisted view, percutaneous canulation for CPB and myocardial protection, etc., make this procedure challenging for all members of the operative room (OR) team. RESULTS: Our favourite set-up include right mini thoracotomy in the IV intercostal space, femoral vein and arterial canulation and an additional venous cannula in the superior vena cava for the drainage of the upper part of the body. Aortic occlusion is achieved usually using an endo-aortic clamp positioned by means of continuous and careful TEE guidance. A mitral valve procedure is realized by direct or video guided view; using adapted and shaft instruments or special atrial retractors all standard techniques are used in this setting. CONCLUSIONS: The literature reports and our published results showed the technique is safe, easy to replicate and allows an excellent rate of valve repair even in more complex patients.
BACKGROUND: Minimally invasive and video assisted mitral valve surgery has been used widely since beginning of 20th. Different reduced surgical approaches allowed replacing or repairing a mitral valve sparing sternal incision. Nevertheless the most used strategy has been in the last years the right mini thoracotomy and the extra thoracic cardiopulmonary bypass (CPB). The main goal is avoiding sternal approach for mitral valve procedures and improve postoperative course of the patients. Some postoperative complication likes blood loss, need for transfusion, prolonged intubation and infection has been reduced using this alternative technique. A special advantages has been reported in elderly or high risk patients and in redo cases. METHODS: Several cardiac centres using videoscopy and a revolutionary set up for CPB management and aortic occlusion have adopted the approach. The team approach, including surgeon, anaesthesiologist, nurse, cardiologist and perfusionist, is crucial for a safe and effective realization of this surgical strategy. The proper use of catheters and Seldinger skilfulness, and the guidance of trans-esophageal echocardiography (TEE) during the procedure are two milestones of this technique. A careful and progressive learning curve is required for all the components of the team. In fact some peculiarity likes modified surgical instruments, 3D and Full HD video assisted view, percutaneous canulation for CPB and myocardial protection, etc., make this procedure challenging for all members of the operative room (OR) team. RESULTS: Our favourite set-up include right mini thoracotomy in the IV intercostal space, femoral vein and arterial canulation and an additional venous cannula in the superior vena cava for the drainage of the upper part of the body. Aortic occlusion is achieved usually using an endo-aortic clamp positioned by means of continuous and careful TEE guidance. A mitral valve procedure is realized by direct or video guided view; using adapted and shaft instruments or special atrial retractors all standard techniques are used in this setting. CONCLUSIONS: The literature reports and our published results showed the technique is safe, easy to replicate and allows an excellent rate of valve repair even in more complex patients.
Entities:
Keywords:
Mitral disease; minimally invasive; team work; videoscopy
Authors: Filip Casselman; Jose Aramendi; Mohamed Bentala; Pascal Candolfi; Rudolf Coppoolse; Borut Gersak; Ernesto Greco; Paul Herijgers; Steven Hunter; Ralf Krakor; Mauro Rinaldi; Frank Van Praet; Geert Van Vaerenbergh; Joseph Zacharias Journal: Ann Thorac Surg Date: 2015-07-07 Impact factor: 4.330
Authors: Ernesto Greco; Juan M Zaballos; Luis Alvarez; Stefano Urso; Ivana Pulitani; Rafael Sàdaba; Arantxa Juaristi; Juan J Goiti Journal: J Heart Valve Dis Date: 2008-01
Authors: Martin Misfeld; Michael Borger; John G Byrne; W Randolph Chitwood; Lawrence Cohn; Aubrey Galloway; Jens Garbade; Mattia Glauber; Ernesto Greco; Clark W Hargrove; David M Holzhey; Ralf Krakor; Didier Loulmet; Yugal Mishra; Paul Modi; Douglas Murphy; L Wiley Nifong; Kazuma Okamoto; Joerg Seeburger; David H Tian; Marcel Vollroth; Tristan D Yan Journal: Ann Cardiothorac Surg Date: 2013-11
Authors: Antonino G M Marullo; Francesco G Irace; Piergiusto Vitulli; Mariangela Peruzzi; David Rose; Riccardo D'Ascoli; Alessandra Iaccarino; Angelo Pisani; Carlotta De Carlo; Giuseppe Mazzesi; Antonio Barretta; Ernesto Greco Journal: Biomed Res Int Date: 2015-10-08 Impact factor: 3.411