Minimally Invasive Aortic Surgery Experience in Peru
Julio A. Moron Castro1, Yemmy Perez Valverde1, Josias Ríos Ortega1, Josue Sisniegas1, Julio Cesar Castillo2
1Instituto Nacional Cardiovascular INCOR Essalud, Lima, Peru, 2Instituto Nacional Cardiovascular INCOR. Essalud, Lima, Peru
BACKGROUND: Aortic surgery classically is performed by full sternotomy, but since two decades ago, minimally invasive aortic approach has grown and represent a good alternative for patients,
METHODS: We review 73patients with minimally invasive aortic surgery from june 2012 until november 2020 at National Cardiovascular Institute INCOR , Essalud , in Lima, Perú. All patients had femoral canulation . Initially until 2014 we prefer upper hemisternotomy with intermitent blood cardioplejia (21 cases) and thereafter we used anterior thoracotomy associated with custodiol cardioplejia (52 cases). All cases in direct vision.
RESULTS: There were 46 male (63%) and 27 female (36.9%) patients.Median age were 54 years ( 30 - 83 y), mean weight 69.9 Kg, mean height 1.62m, mean IMC 26.37, there were 62 patients with severe stenosis , 10 patients with aortic insufficiency and 1case with aneurismatic aortic roof.There were 71 aortic valve replacement (62 for aortic stenosis and 9 for insufficiency), 1 case of valve repair and 1 case of Bentall surgery.Mean extracorporeal time 135 sec (96 - 208 sec), aortic clamp time 102 sec (67 - 165 ), extubation time 14.9 hours (4 - 26), ICU stay 2.7 days (2 - 5), mean hospital stay 9.3 days (5 - 14), mean blood loss 250 ml (50 - 650 ml), mean blood transfusion 2.3 unit (0-3 ). Complications : Conversion to sternotomy 2 cases (2.7%), mortality 2 cases ( 2.7%), reoperation for bleeding 2 cases (2.7 %), mean blood transfusions 1.2 unit (0 - 3), lymphorrhage 5 cases (6.3 %), permanent cerebral embolic accident 1 case (1.3 %). 1 patient reoperated 6 months later for prosthetic endocarditis.Actually , all cases in funcional class NYHA I y II , but one case in vegetative state CONCLUSIONS:Minimally invasive aortic surgery is a good alternative , totally feasible, with good results, better than convencional surgery, avoiding complications about sternotomy ( no dehiscence, no mediastinitis), less blood components use, early recuperation, and good aesthetic result. Most surgeons must to adapt to a new time, with new technology, older patients, with high risk conditions. Minimally invasive aortic surgery is a reality and require a change in the philosophy of the surgeon to treat more complex and demand patients.