Nihon Geka Gakkai Zasshi
· 2016 Mar · PMID 27295775
Although a minithoracotomy approach has several advantages over a sternotomy approach in terms of superior cosmesis and faster recovery, coronary artery bypass grafting (CABG) via sternotomy has been the gold standard fo...Although a minithoracotomy approach has several advantages over a sternotomy approach in terms of superior cosmesis and faster recovery, coronary artery bypass grafting (CABG) via sternotomy has been the gold standard for revascularization in multivessel coronary artery disease. Recently, nonsternotomy approaches, including the minimally invasive cardiac surgery CABG (MICS-CABG) via small left thoracotomy, have emerged as safe, effective alternatives. Excellent clinical results have been reported including equivalent mid-term graft patency as compared with a sternotomy approach. Successful use of bilateral internal thoracic arteries in MICS-CABG has also been reported. Although the durability of this approach and its impact on long-term survival have yet to be confirmed, and there is a certain technical learning curve, MICS-CABG will be one important option to treat multivessel coronary artery disease.
Nihon Geka Gakkai Zasshi
· 2016 Mar · PMID 27295774
Although minimally invasive cardiac surgery (MICS) via right minithoracotomy is attracting attention as a minimally invasive approach in cardiac surgery, it has not become a standard, routine approach for mitral valve re...Although minimally invasive cardiac surgery (MICS) via right minithoracotomy is attracting attention as a minimally invasive approach in cardiac surgery, it has not become a standard, routine approach for mitral valve repair. Although it has spread rapidly in Germany (43%) and USA (20.4%), the proportion of MICS in isolated mitral valve repair still comprises only 15.6% of mitral valve repair surgeries in Japan. For safe, assured introduction of MICS as a routine approach under quality control for good surgical and mid- and long-term results, surgeons experienced in mitral valve repair who perform at least 10 mitral valve repairs per year are necessary. A team approach with surgeons, anesthesiologists, perfusionists, and nurses who are highly motivated is also important.
Nihon Geka Gakkai Zasshi
· 2016 Mar · PMID 27295773
In mitral valve repair via a minimally invasive approach, resection of the leaflet is technically demanding compared with that in the standard approach. For resection and suture repair of the posterior leaflet, premarkin...In mitral valve repair via a minimally invasive approach, resection of the leaflet is technically demanding compared with that in the standard approach. For resection and suture repair of the posterior leaflet, premarking of incision lines is recommended for precise resection. As an alternative to resection and suture, the leaflet-folding technique is also recommended. For correction of prolapse of the anterior leaflet, neochordae placement with the loop technique is easy to perform. Premeasurement with transesophageal echocardiography or intraoperative measurement using a replica of artificial chordae is useful to determine the appropriate length of the loops. Fine-tuning of the length of neochordae is possible by adding a secondary fixation point on the leaflet if the loop is too long. If the loop is too short, a CV5 Gore-Tex suture can be passed through the loop and loosely tied several times to stack the knots, with subsequent fixation to the edge of the leaflet. Finally, skill in the mitral valve replacement technique is necessary as a back-up for surgeons who perform minimally invasive mitral valve repair.
Nihon Geka Gakkai Zasshi
· 2016 Mar · PMID 27295772
Minimally invasive aortic valve replacement (MIAVR) is defined as aortic valve replacement avoiding full sternotomy. Common approaches include a partial sternotomy right thoracotomy, and a parasternal approach. MIAVR has...Minimally invasive aortic valve replacement (MIAVR) is defined as aortic valve replacement avoiding full sternotomy. Common approaches include a partial sternotomy right thoracotomy, and a parasternal approach. MIAVR has been shown to have advantages over conventional AVR such as shorter length of stay and smaller amount of blood transfusion and better cosmesis. However, it is also known to have disadvantages such as longer cardiopulmonary bypass and aortic cross-clamp times and potential complications related to peripheral cannulation. Appropriate patient selection is very important. Since the procedure is more complex than conventional AVR, more intensive teamwork in the operating room is essential. Additionally, a team approach during postoperative management is critical to maximize the benefits of MIAVR.
Nihon Geka Gakkai Zasshi
· 2016 Mar · PMID 27295771
The first description of aortic valve replacement (AVR) as minimally invasive cardiac surgery (MICS) was given by Rao et al. in 1993. Recently, the number of MICS-AVR has increased and this procedure has been established...The first description of aortic valve replacement (AVR) as minimally invasive cardiac surgery (MICS) was given by Rao et al. in 1993. Recently, the number of MICS-AVR has increased and this procedure has been established as the routine standard operative technique in some institutes. MICS-AVR can be performed with two different approaches. One is an upper partial sternotomy and the other is a right small anterior minithoracotomy. MICS-AVR via upper partial sternotomy can be performed without any special instruments and the technical hurdles are relatively few, but the cosmetic benefit is limited. MICS-AVR via right anterior minithoracotomy offers maximal cosmetic benefit, but the technical hurdles are fairly high. For MICS-AVR, longer aortic clamping time and cardiopulmonary bypass time are needed, but this disadvantage can be overcome with sutureless aortic valve repair, and therefore this procedure may become a standard open surgical procedure in the era of transcatheter aortic valve implantation.
Nihon Geka Gakkai Zasshi
· 2016 Mar · PMID 27295770
Minimally invasive surgery is an attractive choice for patients undergoing major cardiac surgery. We review the history of minimally invasive valve surgery in this article. Due to many innovations in surgical tools, card...Minimally invasive surgery is an attractive choice for patients undergoing major cardiac surgery. We review the history of minimally invasive valve surgery in this article. Due to many innovations in surgical tools, cardiopulmonary bypass systems, visualization systems, and robotic systems as well as surgical techniques, minimally invasive cardiac surgery has become standard care for valve lesion repair. In particular, aortic cross-clamp techniques and methods for cardioplegia using the Chitwood clamp and root cannula or endoballoon catheter in combination with femoro-femoral bypass systems have made such procedures safer and more practical. On the other hand, robotically assisted surgery has not become standard due to the cost and slow learning curve. However, along with the development of robotics, this less-invasive technique may provide another choice for patients in the near future.
Nihon Geka Gakkai Zasshi
· 2016 Mar · PMID 27295769
Minimally invasive cardiac surgery (MICS), first introduced in the 1990s, was originally performed via partial sternotomy, the subxyphoid approach, and right anterolateral thoracotomy. Over the past 20 years, MICS proced...Minimally invasive cardiac surgery (MICS), first introduced in the 1990s, was originally performed via partial sternotomy, the subxyphoid approach, and right anterolateral thoracotomy. Over the past 20 years, MICS procedures have progressed from mere alternatives to standard full sternotomy to endoscope-assisted and then to totally endoscopic open-heart procedures. MICS has gained popularity among surgeons and patients; without sacrificing the safety level and durability of cardiac procedures equivalent to median sternotomy, refinement of MICS technologies has resulted in a decrease in length of hospital stay, less postoperative pain, faster patient recovery, and faster return to activities of normal daily living. Such refinements were achieved not only by the tireless efforts of surgical pioneers but also by the introduction of surgical instruments and endoscopic technologies as well as various, techniques for peripheral cardiopulmonary bypass. On the other hand, an increase in the number of interventions in structural heart diseases such as transcatheter aortic valve implantation, MitraClip percutaneous mitral valve repair therapy, and closure of atrial septal defect is a motivation for further improvement of MICS technologies to enhance safety, durability, and reproducibility.