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OBJECTIVE: To establish a minimally invasive cardiac surgical program in a developing country.
METHODS: Methods: A cardiac surgical team consisting of a Surgeon, Anesthesiologist, perfusionist and nurse travelled to Cairo, Egypt, to assist a local program in developing a MICS program. A stepwise introduction of technology and team based approach was utilized. The training involved all aspects of patient care. Follow-up was obtained via communication with the Egyptian team.
RESULTS: There were 6 visits since 2011. 71 operations were performed. 55% were men and the mean age was 61+/- 12 years. The operations consisted of 21 AVR, 24 MVR, 10 MVR / TVR, 4 AVR / MVR, 7 MIDCAB, 2 ASD closure, 2 AVR / septal myectomy and 1 MVR /septal myectomy. All operations were performed by the local team with the assistance of the visiting group. 43% of the valve cases were reoperations. There were 6 mini-sternotomies (AVR) and the remaining cases were done via mini-thoracotomy. Peripheral cannulation was utilized in 93 % of cases . There were no operative mortalities. 30 day mortality was 7 % (5/71). Complications included 4 reoperations for bleeding, 4 prolonged intubation, 4 pleural effusion requiring drainage and 2 kidney injury requiring dialysis.
CONCLUSIONS: It is feasible and safe to establish a MICS program in a developing country. The stepwise introduction of technology is critical, along with a collaborative, team based approach. This model should be applicable to all programs attempting to initiate a MICS program.