Minimally Invasive Extracorporeal Circulation System And Ultra Fast Track Anaesthesia: A 360° Minimally Invasive Approach For Avr
Paolo Berretta, Sr., MD1, Mariano Cefarelli1, Walter Vessella2, Filippo Capestro1, Roberto Carozza3, Carlo Zingaro1, Michele D. Pierri1, Christopher Munch2, Marco Di Eusanio1.
1Cardiac Surgery Unit - Ospedali Riuniti, Polytechnic University of Marche, Ancona, Italy, 2Cardiac Anaesthesia and Intensive Care Unit, Ospedali Riuniti,, Ancona, Italy, 3Perfusion Unit- Ospedali Riuniti, Ancona, Italy.
OBJECTIVE: Due to the availability of significantly less invasive trans-catheter cardiac interventions for the treatment of aortic valve pathology, patients’ expectations have dramatically changed in the last decade with reduced trauma and fast recovery being now strongly valued. Accordingly, an increasing employment of minimally invasive multidisciplinary approaches that call surgeons, anaesthesiologists, perfusionists, nurses and physiotherapists to more efficacious collaborative efforts becomes so crucial to minimize surgical invasiveness as well as to decrease the psychological impact of surgery and fasten patient’s return to pre-operative lifestyle.
METHODS: With this video we would like to present our 360° minimally invasive approach to treat patients who require aortic valve replacement (AVR). It involves: 1) reduced chest incision (through upper ministernotomy or right anterior minithoracotomy), 2) rapid deployment AVR (RD-AVR), 3) minimally invasive extracorporeal circulation (MiECC) system and 4) ultra fast-track (UFT) anaesthesia with table extubation and early rehabilitation therapy.
RESULTS: RD-AVR was performed through a J-ministernotomy using type IV MiECC system. Cross-clamp time and cardio-pulmonary bypass time were 35 and 49 minutes respectively. The patient was extubated in the operating room and the rehabilitation therapy was started 3 hours after the intervention. Total blood loss was 110 cc and no transfusion was required. Postoperative course was uneventful and the patient was discharged on postoperative day 5.
CONCLUSIONS: Our UFT mini AVR program is a multidisciplinary minimally invasive approach that involves the latest best technologies and techniques for AVR. We believe it may considerably increase patient’s comfort, faster recovery and provide superior patients’ outcomes.
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