International Society For Minimally Invasive Cardiothoracic Surgery

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Minimally Invasive Cardiac Surgery: How To Overcome The Learning Curve?
Feras Khaliel, Adam Obad, Zainab Alayed.
King Faisal Specialist Hospital & Research Center- Riyadh, Riyadh, Saudi Arabia.

Background The transition from conventional cardiac surgery approach to the Minimally Invasive Surgeries Cardiac Surgeries (MICS) is very challenging, partially due to the complexity of cases and logistic limitations. We aim to review the learning curve, safety and outcome of a single surgeon in starting up minimally invasive cardiac surgery program Methods This is a prospective cohort study on patient who underwent MICS at single center during the period of December 2017 till September 2018. Groups were based on the surgery type (Aortic, Mitral and Tricuspid, ASD, LVAD) and the approaches: (right mini-thoracotomy, upper hemi-sternotomy with or without left mini-thoracotomy. Means and standard deviations were used to present the demographics and chi-square test along with Pearson correlation were used to test for association and correlation, respectively. Results A total of 48 patients were operated the first three-quarter of starting up year in MICS. Their mean age of 43.7913.2, of whom 25 (52.08%) were females. The group of patients who underwent Upper hemi-sternotomy & left mini-thoracotomy (LVAD-HeartMateIII) were more likely to have moderately or severely reduced RV function post operatively and SSI (p values of 0.005, and 0.002, respectively). No mortality was observed. Additionally, The incidence of the studied morbidities are as follows[N(%)]: Readmission to hospital 6 (12.5%), Reoperation for bleeding 2 (4.2%), Stroke 1 (2.1%), Atrial fibrillation or flutter 12 (25.0%), SSI 2 (4.2%), MI 2 (4.2%). The hospital length of stay was negatively correlated with The preoperative LVEF (p<0.001, r=-0.57), postoperative LVEF (p<0.001, r=-0.52), and quality of life (p=0.003, r=0.44), but positively with EuroSCORE-II (p=0.031, r=0.329). Figure 1. Conclusion Patient with high-risk EuroSCORE, morbid obesity, Pre-Op RV failure, and severe pulmonary hypertension were not obstacles to being selected in starting up MICS program. Perhaps, it has contributed to making our center a high-volume MICS in the country. Forming a qualified team who is consistently assigned for MICS along with careful pre-operative investigation and planning which were taken under measures, have helped in the program's success.

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