Objectives: Optimal cardiopulmonary support during minimally invasive cardiac surgery remains controversial. We developed cardiopulmonary bypass for minimally invasive cardiac surgery using percutaneous peripheral cannulation.Methods: Subjects were 34 patients (age: 58±13 years; range: 17–73) undergoing minimally invasive cardiac surgery using percutaneous cardiopulmonary support between June 1997 and March 1999. Procedures included atrial septal defect closure (n = 14), partial atrioventricular septal defect closure (n = 1), mitral valve replacement (n = 8), mitral valve repair (n = 3), aortic valve replacement (n=6), coronary artery bypass grafting (n = 1), and right atrial myxoma extirpation (n = 1). Bicaval venous drainage from the right internal jugular vein and the femoral vein and arterial return to the femoral artery were instituted by percutaneous cannulation. Venous drainage was implemented by negative pressure (−20 to −40 mmHg) and arterial return was by conventional roller pump. All procedures were conducted through a skin incision 8±1 cm, from 6 to 10 cm and partial sternotomy. Aortic cross clamping and cardioplegic solution were administered in the surgical field.Results: The operation lasted 224±45 min., cardiopulmonary bypass 104±32 min., and aortic clamping 77±23 min., No deaths occurred. One patient with residual atrial septal defect required reoperation through the same skin incision. Only 1 patient required homologous blood transfusion. The average postoperative hospital stay was 15±5 days.Conclusions: Minimally invasive cardiac surgery using percutaneous cardiopulmonary support is safe and an excellent option for selected patients affected by single valve lesion, simple cardiac anomalies, and coronary artery bypass grafting.
minimally invasive cardiac surgery (MICS) percutaneous cardiopulmonary support (PCPS)
This is a preview of subscription content, log in to check access.
Cosgrove III DM, Sabik JF. Minimally invasive approach for aortic valve operations. Ann Thorac Surg 1996; 62: 596–7.PubMedCrossRefGoogle Scholar
Cohn LH, Adams DH, Couper GS, Bichell DP, Rosborough DM, Aranki SF. Minimally invasive cardiac valve surgery improves patient satisfaction while reducing costs of cardiac valve replacement and repair. Ann Surg 1997; 226: 421–28.PubMedCrossRefGoogle Scholar
Landerneau RJ, Mack MJ, Hazelrigg SR, Dowling RD, Acuff TE, Magee, et al. Basic technical concepts and intercostal approach strategies. Ann Thorac Surg 1992; 54: 800–7.CrossRefGoogle Scholar
Dubois F, Icard P, Berthelot G, Evard H. Coelioscopic cholecystectomy. Preliminary report of 36 cases. Ann Surg 1990; 211: 60–2.PubMedCrossRefGoogle Scholar
Benetti FJ. Direct coronary surgery with saphenous vein bypass without either cardiopulmonary bypass or cardiac arrest. J Cardiovasc Surg 1985; 26: 217–22.Google Scholar
Benetti FJ, Ballester C. Use of thoracoscopy and a minimal thoracotomy in mammary-coronary bypass to left anterior descending artery, without extracorporeal circulation: Experiences in 2 cases. J Cardiovasc Surg 1995; 36: 159–61.Google Scholar
Sasaki S, Yasuda K, Matsui Y, Aoi K, Gando S, Kemmotsu O. Therapeutic strategy of postoperative use of percutaneous cardiopulmonary bypass support for adult cardiac surgery. Jpn J Thorac Cardiovasc Surg 1999; 47: 20–6.PubMedGoogle Scholar