The First 100 Minimally Invasive Cardiothoracic Cases
AHMED F. ELMAHROUK, Abdulbadee Bogis, Uthman Aluthman, Ahmed Jamjoom.
King Faisal Specialist hospital and research center, JEDDAH, Saudi Arabia.
Background: In this report we present our experience in the first 100 cases of minimally-invasive cardiac surgery, to share lessons learned and methods to solve obstacles encounteredMethods: We extracted data of all MICTS during the period from September 2018 till September 2019. We included patients underwent Minimally Invasive MV surgeries, AV surgeries, Robotic-Assisted CABG, TAVR and Valve-in-valve procedure. We have also included other procedures like intra-cardiac mass excision and ASD repair.Our data included, number of procedures, Procedure types, rate of conversion to standard techniques, LOS, cost of procedure compared to conventional surgery for the same procedure and early outcomes.Results:We studied 197 patients, 98 patients had minimally-invasive valve procedures, 60% of them underwent MV surgeries, 40% underwent AVR through mini-sternotomy.38 patients underwent Robotic-assisted CABG, 9 of them had multi-vessels disease underwent subsequent PCI. 52 patients underwent transcatheter procedures, that included 39 patients underwent TAVR, 6 patients received valve-in-valve for degenerated tissue Mitral valve prothesis and four patients received LAAO Device.Conversion rate was 4.1%, the reason for conversion was hemodynamic instability in 3 robotic cases, intra-mural course of LAD in two robotic cases.The Overall LOS for all patients was 6 ±7 days. Despite that, the procedural cost was higher in MICS compared to standard procedures particularly in Robotic-Assisted surgery. We had zero early-mortality, however, 4 patients had early re-operations, MVP return to the OR for replacement due to significant gradient, one AVR return due to paravalvular leak and two for postoperative bleeding.Conclusions:MICS is as safe as conventional surgery. Although our initial experience, showed marked increase in the financial cost/procedure particularly in Robotic-Assisted Procedures. However, with the learning curve and improvement of patients' outcomes will ease what can be a rough initial transition and reduce costs due to a shorter LOSand in-turn will maximize long-term financial revenue.
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