A Protocol-based Strategy To Minimally Invasive Cardiac Reoperation For Atrioventricular Valve
Xiaoshen Zhang, Sr., Shengjie Liao, Sr.
The First Affiliated Hospital of Jinan University, Guangzhou, China.
BACKGROUND:With aging population, more and more cardiac reoperation is needed. The minimally invasive approach has better surgical outcome. Since the long learning curve and difficulty to master of minimally invasive cardiac reoperation (MICR), it’s a challenge and unpredictable operation, especially for a young surgeon.
METHODS: A protocol-based strategy for MICR was applied routinely during the clinical practice.This strategy for MICR is based on a protocol included the routine use of the following: (1)preoperative computed tomography angiography, (2)avoidance of lung injury during the adhesion dissection, (3)appropriative vacuum-assisted venous drainage and arterial perfusion flow, (4)patient grouping based on the implant removement required or not, (5)no need to dissect the atrium form the pericardium, (6)use of electric scalpel to remove the dysfunctional implant, (7)use of monofilament polypropylene suture in where need great force like posterior annuloplasty.
RESULTS: The importance and benefit of a protocol-driven strategy to the cardiac reoperation has been reported increasingly. It can improve the operative efficiency and patient outcome. Our protocol-based strategy for MICR is concluded from more than 1000 minimally invasive cardiac surgery in clinical practice. This strategy for MICR can standardize and simplify the MICR surgery
CONCLUSIONS:Our protocol-based strategy for MICR can standardize and simplify the MICR surgery, which help surgeon easier to master this technique with less complication rate.
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