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Port-Access cardiac surgery using endovascular cardiopulmonary bypass: theory, practice, and results
H Reichenspurner1, A Welz, V Gulielmos
1Department of Cardiac Surgery, Ludwig-Maximilians-University Munich, Germany.
Insights
Endovascular cardiopulmonary bypass (EndoCPB) enables minimally invasive cardiac surgery for complex procedures. This approach avoids sternotomy, offering a safe alternative with high survival rates and minimal complications.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Techniques
- Medical Devices
Background:
- Minimally invasive cardiac surgery aims to reduce surgical trauma.
- Traditional cardiopulmonary bypass is essential for many cardiac procedures but limits invasiveness.
- Endovascular cardiopulmonary bypass (EndoCPB) offers a solution for less invasive complex cardiac surgeries.
Purpose of the Study:
- To evaluate the feasibility and outcomes of the EndoCPB system for minimally invasive cardiac surgery.
- To assess the safety and efficacy of EndoCPB in procedures requiring cardiopulmonary bypass.
Main Methods:
- The study utilized the EndoCPB system, with over 1100 procedures performed globally since 1995.
- The authors report their experience with 60 Port-Access coronary artery bypass grafts, 34 mitral valve procedures, 5 atrial septal defect closures, and 3 atrial myxoma removals.
- Procedures were performed using the Port-Access technique, allowing surgery on an empty, arrested heart.
Main Results:
- Overall patient survival rate was 99%, with low incidences of perioperative stroke (1%) and aortic dissection (1%).
- Port-Access mitral valve and atrial septal defect procedures demonstrated 100% survival without peri- or postoperative complications.
- Transesophageal echocardiography confirmed no perivalvular leak or mitral insufficiency post-repair.
Conclusions:
- The EndoCPB system facilitates true Port-Access minimally invasive cardiac surgery for procedures needing cardiopulmonary bypass.
- This approach successfully avoids sternotomy and its associated complications.
- EndoCPB ensures safe myocardial protection and surgical execution on an arrested heart.
Background:
Reduction of surgical trauma is the aim of minimally invasive cardiac surgery. This can be achieved by reducing the size of the incision or by eliminating or changing the cardiopulmonary bypass system. However, certain cardiac surgical procedures, such as valvular surgery and complex multivessel coronary artery surgery, are not feasible without the use of cardiopulmonary bypass. Therefore endovascular cardiopulmonary bypass may allow reduction of surgical trauma for these patients.
Methods:
Since its first application in April 1995, more than 1100 procedures have been performed worldwide using the EndoCPB endovascular cardiopulmonary bypass system. The authors' experience consists of 60 Port-Access coronary artery bypass grafting procedures, 34 Port-Access mitral valve procedures (18 replacements, 16 repairs), 5 atrial septal defect closures, and 3 atrial myxoma removals.
Results:
The patient survival rate was 99%, the incidence of perioperative stroke was 1%, and the incidence of aortic dissection was 1%. In the Port-Access mitral valve and atrial septal defect patients, the survival rate was 100% with no peri- or postoperative complications. Peri- and postoperative transesophageal echocardiography revealed no perivalvular leak or remaining mitral insufficiency after valve repair.
Conclusions:
The EndoCPB endovascular cardiopulmonary bypass system allows the application of true Port-Access minimally invasive cardiac surgery in procedures that require the use of cardiopulmonary bypass and cardioplegic arrest. Sternotomy and its potential complications can be avoided, and the surgical procedures can be performed safely on an empty, arrested heart with adequate myocardial protection.