Direct Cannulation In Thoracotomy MICS
Pramod R. Kandakure, Sai Nagendra Banovath, Mohan Nelli, Tejaswini Kandagatla.
Medicover Hospital, Hyderabad, India.
Introduction-With increasing patient interest in minimally invasive procedures, it is more important than ever for surgeons to be current on the most common minimally invasive techniques in cardiac surgery. As MICS has evolved, the strategies and approaches to CPB access have evolved. Peripheral cannulation is convenient but carries a risk of retrograde dissection, embolization, stroke and ipsilateral limb ischemia. Whereas, central aortic cannulation has the advantage of antegrade flow. Also it is difficult to cannulate femoral vessels in pediatric age group.Methods-We report our experience with direct arterial and venous cannulation through thoracotomy approach without compromising the results. From January 2017 to October 2021, 560 patients underwent minimally invasive surgery. Mean age was 30 ± 15 years (range 10mths-83 years), with 140(33.3%) patients younger than 12 years. Spectrum of procedures include ASD closure (33%), Mitral Valve Repair (14%), VSD closure (8%), Aortic valve replacement (15%), Mitral valve replacement (18%), Repair of PAPVC (9%), Myxoma excision (2%), VSD closure with pulmonary valvotomy (1%).Results- None of the patients were converted from a minimally invasive to standard median sternotomy. One patient with VSD died due to pulmonary hypertensive crises. No patient required rexploration for bleeding and none had stroke, renal failure. Two patients had delayed wound healing. There were no myocardial infarctions or aortic dissections.Conclusion- In our experience, this approach is a reliable platform for a variety of MICS procedures and has resulted in low complication rates. The technique can be applied safely to both paediatric and adult population. Also, it is very cost effective as regular instruments and cannulas are used. Published in Annals of thoracic surgery in July 2019
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