Less invasive intracardiac surgery performed without aortic clamping

Area of Science:

• Cardiovascular Surgery
• Minimally Invasive Cardiac Surgery
• Thoracic Surgery

Background:

• Aortic clamping and cardioplegia complicate intracardiac procedures via right minithoracotomy.
• Mitral valve (MV) procedures on a fibrillating heart show promising outcomes.
• This study reviews the experience with the fibrillating heart approach for MV procedures.

Purpose of the Study:

• To evaluate the feasibility and outcomes of intracardiac procedures performed on a fibrillating heart.
• To assess the safety and efficacy of right minithoracotomy for these procedures.
• To compare outcomes with conventional cardiac surgery techniques.

Main Methods:

• 100 patients underwent various MV procedures, septal defect closure, tricuspid valve repair, or myxoma excision.
• Procedures were performed on a fibrillating heart without aortic cross-clamping via right minithoracotomy with peripheral cannulation.
• Combined procedures included modified maze and minimally invasive direct coronary artery bypass grafting (MIDCABG).

Main Results:

• Mean fibrillation time was 73 minutes; no conversions to sternotomy were required.
• Hospital mortality was 1% (one death from mesenteric ischemia); complications included bleeding (4%) and stroke (2%).
• Median hospital stay was five days; all survivors improved to NYHA class I or II, with no need for reoperation.

Conclusions:

• Performing intracardiac procedures on a fibrillating heart simplifies the surgery.
• This approach is associated with reduced complication rates and perioperative mortality.
• Right minithoracotomy on a fibrillating heart is a safe and effective alternative to conventional surgery.