Minimal İnvaziv Aort Kapak Değişimi,
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- Mini AVR through right anterior thoracotomy (RAT) was first performed in 1996 and offers benefits like less atrial fibrillation, bleeding, and ventilation/hospitalization times compared to full sternotomy. - Prevalence is around 20-29% in Germany and USA but only 12% in UK. It allows for better cosmesis, less pain, better wound healing and respiratory function. - Pre-operative CT scanning and planning is key to determine patient suitability and surgical approach. Factors like aortic valve position and chest cavity size help decide between RAT or other mini-invasive approaches. - The sutureless Perceval valve allows for shorter cross-clamp and bypass
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Minimal İnvaziv Aort Kapak Değişimi,
- 1. Mini AVR Right Anterior Thoracotomy Selim Isbir MD Professor of Cardiovascular Surgery Marmara University Medical School Istanbul Turkey
- 2. Minimally Invasive Cardiac Surgery
- 3. Facts • First Mini AVR is performed in 1996 by Cosgrove • Benefits – Less Afib – Less Bleeding – Shorter Ventilation times – Shorter Hospitalization • Prevelance – 29% in Germany – 20% in USA (3.6% RAT) – 12% in UK
- 4. Mini AVR • Better cosmesis • Less pain • Better wound healing • Better respiratory function • Less adhesion
- 6. Poor Penetration • Lack of clinical data – Mini AVR should be done without compromising the patient • Increased technical demands – Increased ischemic and cardiopulmonary times – Complex Surgery
- 7. J Sternotomy Mini AVR RAT from 2nd Intercostal space
- 8. Pre-operative Sizing and Planning is Key for Success 80% of the Case is Done Before You Even Open the Chest
- 9. Preop CT – Relation between the Aortic Valve and the 4th ICS • Above the 4th ICS – J Sternotomy • Below the 4th ICS – Lower Sternotomy
- 10. Preop CT – Relation between the Aortic valve and the Sternum • Right sided aorta- RAT • Left sided aorta- J sternotomy • Deep Thoracic cavity – >10 cm is not suitable for RAT
- 11. Contraindications (Relative) • Calcified aorta or Dilated aorta • Chest wall deformities • Reoperations ( CABG !!!, Right chest ) • History of Right Pleural Disease • Previous Radiotherapy • Narrow ICS
- 12. Surgical Technique • Selective intubation • TEE is mandatory • External Defibrillator pads • Small pillow under the right chest • A skin incision through the 2 nd or 3rd ICS – Preferably 2 nd ICS • Internal Mammary artery divided • Soft tissue retractor
- 13. Surgical Technique • Multiple pericardial stiches • Ascending aortic cannulation preferred but femoral artery can be used if the peripherals are free of calcified plaques • Femoral Vein cannulation • Direct Ascending aortic cross clamp – Flexible or Glauber • Std Cardioplegia / Custodiol • Vent through the PA or RSPV
- 14. “Sutureless” Valve 3.5 cm Fat pad Transverse Aortotomy Balloon Dilatation
- 16. In all ages Age >85
- 17. LESS AFIB LESS BLOOD TRANSFUSION LESS HOSPITAL STAY SIMILAR SURVIVAL
- 19. Collapsing
- 21. Visibility
- 23. Conclusion • Mini AVR through the RAT with Perceval – Easy to use – Allows shorter X-clamp and CPB times – Gives you a better visibility – Safe procedure
- 24. Thank You......
- 25. Mini AVR • Better cosmesis • Less pain • Better wound healing • Better respiratory function • Less adhesion
- 26. Minimally Invasive Cardiac Surgery
Editor's Notes
- The mini Invasive approach is a hot topic in the last ten years. Our cardiology colleaques are doing great jobs. They are trying to do some of our procedures from needle holes. So as a cardiac surgeons we have to improve our techniques to improve patient outcomes. With the aid of the technology we can do most of our procedures from small incisions and get better results.
- The mini Invasive approach is a hot topic in the last ten years. Our cardiology colleaques are doing great jobs. They are trying to do some of our procedures from needle holes. So as a cardiac surgeons we have to improve our techniques to improve patient outcomes. With the aid of the technology we can do most of our procedures from small incisions and get better results.