This document discusses minimally invasive cardiac surgery techniques, specifically videoscope-assisted cardiac surgery (VACS). It notes that VACS uses 2D imaging without tactile feedback compared to direct vision in more invasive surgeries. Issues discussed include patient positioning, cannulation methods, myocardial protection routes, the ability to perform equivalent procedures, and hemostasis challenges. The document outlines the benefits and risks of VACS and robotic-assisted surgeries for procedures like CABG, mitral valve, aortic valve, and robotic mitral valve repair. Preoperative variables that may make a patient a good candidate for minimally invasive procedures are also examined.

1. Minimally Invasive Cardiac Surgery
--Videoscope-assisted cardiac surgery
(VACS)
陳勁辰
亞東醫院
台灣 新北市

3. Minimally Invasive CS (MICS)
• Minimal access CS (MACS)
• Videoscope-assisted CS (VACS)
– Cf: Direct vision in MICS/MACS
– Thoracoscopic: 2D images, tactile, self
– da Vinci robotic: 3D images, non-tactile, $,
assistant

4. Issues
• Prep: positioning, e-shock pads
• Cannulation: peripheral
• Myocardial protection: route
• Procedure as good as open*
• Hemostasis
• Pain

5. Outlines
• Benefits & risk
• Preop
• Op
• ====
• Robotic-assisted CABG
• Mitral valve
• Aortic valve
• Robotic mitral

6. Preop Variables for Choosing MICS (MPS, MTC)
in Low-Risk Cases (Elective, LVEF>=30%, and
EuroScore-II<=10%)
N=722 OR OR 95% CI p-value
EuroScore-II 0.77 (per 1%) 0.69 ~ 0.85 <0.01
Non-MS MR 1.84 1.06 ~ 3.20 0.031
HOCM 0.08 0.02 ~ 0.30 <0.001
MPS: Mini-parasternotomy
MTC: Mini-thoracotomy
MICS(minimally-invasive cardiac surgery): MPS or MTC
Initial variable set: MR, MS, AS, AR, TR, Af, IE, HOCM;
sex, age, DM, HTN, uremia, EuroScore-II,
Multiple logistic regression with stepwise selection

7. Pre-Op
• Endoscopic vein harvesting: Vein echo
mapping
• EuroScore-II
• Lung function: one -lung
• Chest non-contrast CT: aorta, anatomy
• Ankle-Brachial index: femoral artery
• Carotid doppler: stroke
• Workup for medical condition

22. Valves
• Parasternal
– Aortic valve
• Thoracotomy
– Mitral valves
– Others
• Heart echo: confirm, new lesion?

24. Schematic illustrations (1)

25. Schematic illustrations (2)

26. Less Invasive Mitral Valve Surgery

27. Pre-operative Image
Pleural adhesion?
AP diameter Cardiac axis

28. Scope-Assisted MICS

29. Positioning

30. Vacuum-Assisted Venous Drainage

32. Figure 1

34. Figure 2
A B
C D

35. Figure 3
A B
C D

36. D
BA
C
Figure 4

38. da Vinci Robotic MVR

41. Delacroix-Chevalier Instruments

46. THANK YOU!

47. Op Tech in Thorac Cardiovas Surg 2007: 235-249

48. Op Tech in Thorac & Cardiovas Surg 2007: 235-249

49. Op Tech in Thorac Cardiovas Surg 2007: 235-249

50. Op Tech in Thorac Cardiovas Surg 2007: 235-249

51. Op Tech in Thorac Cardiovas Surg 2007: 235-249

52. Op Tech in Thorac Cardiovas Surg 2007: 235-249

53. Op Tech in Thorac Cardiovas Surg 2007: 235-249

54. Op Tech in Thorac Cardiovas Surg 2007: 235-249

55. Op Tech in Thorac Cardiovas Surg 2007: 235-249