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The minimally invasive approaches in cardiac surgery - 5-years of experience
Berik Bolatbekov, Dr., Ikrom Mukhamedov, Dr., Almas Alibekov, Dr., Erbol Ustemirov, Dr., Aiman Issakova, Dr., Amirhan Baimagambetov, Prof.MD, Seithan Dzhoshibaev, Prof.MD.
Resaerch clinical center of cardiac surgery and transplantation, Taraz, Kazakhstan.
OBJECTIVE: The aim of this study was to assess the results of a 5-year experience with a minimally invasive operation that requires mini thoracotomy and partial sternotomy.
METHODS: 1538 patients were operated in the period from March 2009 till December 2013. They were divided into 2 groups by type of approach: First group included patients with minimally invasive surgery - 298 (19%), and in the second group patients were operated by standard sternotomy - 1240 (81%). The minimal invasive approaches were determined by chest X-ray in frontal projection taking into account localization of the aortic root and diaphragm-pericardial angle with subsequent intercostal space. Types of minimally invasive operations: ASD closures on a beating heart through anterior right minithoractomy-177 cases, and 2 cases through the lower ministernotomy in the form as inverted "hockey-stick." In 2 cases there were performed concomitant RFA of the pulmonary veins. VSD closures through the anterior right minithoracotomy were performed in 60 cases, through the lower ministernotomy in the form as inverted "hockey-sticks"-6 cases. Aortic valve replacement through a transverse sternotomy were made in 12 cases, with the upper ministernotomy as "hockey-stick" were 4 cases. Mitral valve replacement through anterior right minithoracotomy were 39 cases, also in 2 patients there were performed RFA of the pulmonary veins.
RESULTS: Using minimally invasive surgical approaches were not limited by surgical techniques, so the average time of aortic cross-clamping and CPB did not differ significantly. But total duration of the operation in group 1 was shorter (175 ± 15 vs 225 ± 22 minutes, p<0.0001). Also we revealed decreased blood loss by drainages (66 ± 23 vs 102 ± 26 ml, p<0.0001), shorter ventilation time (115 ± 32 vs 152 ± 22 hours, p<0.0001), earlier discharge from hospital (7,0 ± 1,7 vs 10 ± 1,8 days, p<0.0001), reduction of wound infecting and divergence, lower mortality and improved quality of life.
CONCLUSIONS: The main advantages of minimal access is preserved carcasses of the chest, less blood loss by drainages, low probability of infectious complications, achieving cosmetic effect and improved quality of life.
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