Starting A Minimally Invasive Cardiac Surgery Program At The End Of Training: The First Ten Years
Hugues Jeanmart, Pierre Demondion, John Aoun, Eliza Calin, Carole Sirois, Pierre Pagé.
Hôpital du Sacré-Coeur de Montréal, montreal, QC, Canada.
Background: With the increase interest in the surgical community for minimally cardiac surgery, the question of when to safely start a new program for a young surgeon remains open. The aim of this study was to review the results of the first ten years of the minimally invasive mitral and coronary surgery in our institution, in a program started right at the end of fellowship training. Method: From December 2006 to December 2017, 387 underwent a minimally invasive mitral or coronary surgery in our institution by one surgeon. Demographic and clinical data were prospectively and retrospectively obtained from the patient files. Results: One hundred and sixty patients underwent a minimally invasive endoscopic mitral surgery (repair: 134, RVM: 26). Complication rate were low (mortality: 1 (0.6 %), myocardial infarction: 4 (2.5 %), stroke: 2 (1.3 %), reoperation for bleeding: 1 (0.6%)) and there was 5 intraoperative conversion to sternotomy (3.1 %). Repair rate was 98.5 % and 132 (98.5 %) patients left the hospital with no significant mitral regurgitation. During the same period, 227 patients underwent a minimally invasive robotic coronary surgery (220 LIMA to the LAD and 7 BIMA). Complication rate were low (mortality: 1 (0.04%) , myocardial infarction: 4 (1,7 %), stroke: 1 (0.04%), reoperation for bleeding: 1 (0.04%), early graft revision: 2 (0.08%) and there was 3 (1.3 %) intraoperative conversion to sternotomy. Across the decade, there was a progressive reduction in operative time for both procedures and an increase in the number of minimally invasive cardiac surgery cases performed annually, but there was no significant difference between quartile in term of complications or conversion rate. Conclusion: Based on these results, starting a minimally invasive cardiac surgery program, right after fellowship training, for a young surgeon is safe.
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