Periareolar Approach in Cardiac Surgery
Lizeth Dayana Saldaña Morales, Alberto Alejandro Quintero Gómez, Juan Camilo Rendón Isaza, Juan Santiago Jaramillo Isaza.
Clinica Cardio VID, Medellin, Colombia.
The aim of this report is to describe the 38 patients who underwent minimally invasive cardiac surgery by periareolar approach and their outcomes in the first 30 days.
From Januray 2015 to August 2016, we included 38 patients who underwent a minimally invasive cardiac surgery procedure by periareolar incision.
All patients with Cardiopulmonary bypass ( 37 of 38), we used femoral vessels for cannulation and with right atrium surgeries, the internal yugular vein on the same side was used for bicaval cannulation. All cannulations were performed with Seldinger technique and by transesophageal echocardiographic guiadance. The cardiac arrest was induced with Del Nido Cardioplegia. Only one patient was performed without cardiopulmonary bypass.
The majority of patients were women 35 of 38. The mean age was 49 ± 9,7 years and BMI 26 ± 4.
The procedures were: 14 atrial septal defect closures (12 ostium secundum and 2 sinus venosus), 10 mitral valve replacements, 6 mitral valve repairs, 3 mitral replacements with concomitant procedures ( Maze, tricuspid repair and atrial septal repair) , 2 myxoma resection in left atrium, 1 tricuspid repair with atrial septal closure, 1 atrial septal closure with peacemaker wire removal and 1 atrial repair due to a peacemaker wire perforation
The mean cross clamp time was: 64 ±24 minutes and perfusion time 103 ± 44 minutes. The mean chest drainage was 305 cc during the first day. The median ICU stay was 26 hours (0-120) and post-operative stay was 5 days ( 2 -17) .
We had three complications: 2 hemothorax and 1 AV block.
We reported 0 deaths.
The periareolar approach for MICS is a good choice for mitral valve and tricuspid valve surgery, atrial septal defect ( ostium secundum and venous sinus), concomitant procedures as Maze Procedure, and removal of peacemaker wires. The incidence of complications is similar to the traditional MICS incision with excellent esthetics results.
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