Advertisement

Zugangswege in der Herzchirurgie

  • Dominik WiedemannEmail author
Chapter
  • 600 Downloads

Zusammenfassung

Der Zugang zum Herzen und zu den großen Gefäßen im Thorax ist durch den knöchernen Brustkorb erschwert. In der Herzchirurgie hat sich die mediane Sternotomie als primärer Zugangsweg fest etabliert; lediglich in speziellen Situationen werden andere Thorakotomien bevorzugt. Im Vergleich mit anderen chirurgischen Fachbereichen haben sich interventionelle und minimal-invasive Zugangswege in der Herzchirurgie erst relativ spät etablieren können, sodass nunmehr neben der medianen Sternotomie auch verschiedene Minithorakotomien und sogar total-endoskopische Zugangsoptionen zur Verfügung stehen.

Literatur

  1. Bonaros N, Schachner T, Lehr E, Kofler M, Wiedemann D, Hong P, Wehman B, Zimrin D, Vesely MK, Friedrich G, Bonatti J (2013) Five hundred cases of robotic totally endoscopic coronary artery bypass grafting: predictors of success and safety. Ann Thorac Surg 95:803–812PubMedGoogle Scholar
  2. Bonatti J, Lehr EJ, Schachner T, Wiedemann D, Weidinger F, Wehman B, de Biasi AR, Bonaros N, Griffith B (2012) Robotic total endoscopic double-vessel coronary artery bypass grafting-state of procedure development. J Thorac Cardiovasc Surg 144:1061–1066PubMedGoogle Scholar
  3. Bruhin R, Stock UA, Drücker JP, Azhari T, Wippermann J, Albes JM, Hintze D, Eckardt S, Könke C, Wahlers T (2005) Numerical simulation techniques to study the structural response of the human chest following median sternotomy. Ann Thorac Surg 80:623–630PubMedGoogle Scholar
  4. Brutel de la Rivière A, Brom GH, Brom AG (1981) Horizontal submammary skin incision for median sternotomy. Ann Thorac Surg 32:101–104PubMedGoogle Scholar
  5. Casha AR, Manché A, Gauci M, Camilleri-Podesta MT, Schembri-Wismayer P, Sant Z, Gatt R, Grima JN (2012) Placement of trans-sternal wires according to an ellipsoid pressure vessel model of sternal forces. Interact Cardiovasc Thorac Surg 14:283–287PubMedGoogle Scholar
  6. Casha AR, Manché A, Gatt R, Duca E, Gauci M, Schembri-Wismayer P, Camilleri-Podesta MT, Grima JN (2014) Mechanism of sternotomy dehiscence. Interact Cardiovasc Thorac Surg 19:617–621PubMedGoogle Scholar
  7. Cohn WE (2010) A transthoracic, left ventricular vent facilitates challenging sternal reentry. Ann Thorac Surg 90:679–680PubMedGoogle Scholar
  8. Cotogni P, Barbero C, Rinaldi M (2015) Deep sternal wound infection after cardiac surgery: evidences and controversies. World J Crit Care Med 4:265–273PubMedPubMedCentralGoogle Scholar
  9. Davison SP, Clemens MW, Armstrong D, Newton ED, Swartz W (2007) Sternotomy wounds: rectus flap versus modified pectoral reconstruction. Plast Reconstr Surg 120:929–934PubMedGoogle Scholar
  10. Deutinger M, Domanig E (1992) Breast development and areola sensitivity after submammary skin incision for median sternotomy. Ann Thorac Surg 53:1023–1024PubMedGoogle Scholar
  11. Doty DB, Flores JH, Doty JR (2000) Cardiac valve operations using a partial sternotomy (lower half) technique. J Card Surg 15:35–42PubMedGoogle Scholar
  12. Haberl T, Riebandt J, Mahr S, Laufer G, Rajek A, Schima H, Zimpfer D (2014) Viennese approach to minimize the invasiveness of ventricular assist device implantation. Eur J Cardiothorac Surg 46:991–996PubMedGoogle Scholar
  13. Healey S, O’Neill B, Bilal H, Waterworth P (2013) Does retraction of the sternum during median sternotomy result in brachial plexus injuries? Interact Cardiovasc Thorac Surg 17:151–157PubMedPubMedCentralGoogle Scholar
  14. Heilmann C, Stahl R, Schneider C, Sukhodolya T, Siepe M, Olschewski M, Beyersdorf F (2013) Wound complications after median sternotomy: a single-centre study. Interact Cardiovasc Thorac Surg 16:643–648PubMedPubMedCentralGoogle Scholar
  15. Imran Hamid U, Digney R, Soo L, Leung S, Graham AN (2015) Incidence and outcome of re-entry injury in redo cardiac surgery: benefits of preoperative planning. Eur J Cardiothorac Surg 47:819–823PubMedGoogle Scholar
  16. Ishikawa N, Watanabe G (2015) Robot-assisted cardiac surgery. Ann Thorac Cardiovasc Surg 21:322–328PubMedPubMedCentralGoogle Scholar
  17. Kamiya H, Al-maisary SS, Akhyari P, Ruhparwar A, Kallenbach K, Lichtenberg A, Karck M (2012) The number of wires for sternal closure has a significant influence on sternal complications in high-risk patients. Interact Cardiovasc Thorac Surg 15:665–670PubMedPubMedCentralGoogle Scholar
  18. Kawahito K, Adachi H, Ino T (2005) Anterolateral thoracotomy for distal aortic arch disease. Surg Today 35:929934Google Scholar
  19. Klesius AA, Dzemali O, Simon A, Kleine P, Abdel-Rahman U, Herzog C, Wimmer-Greinecker G, Moritz A (2004) Successful treatment of deep sternal infections following open heart surgery by bilateral pectoralis major flaps. Eur J Cardiothorac Surg 25:218–223PubMedGoogle Scholar
  20. Krejca M, Szmagała P, Skarysz J, Bochenek K, Ulczok R, Bis J, Bochenek A (2003) Force distribution in wire sternum sutures: the consequences for sternal closure rigidity. Med Sci Monit 9:134–144Google Scholar
  21. Luciani GB, Lucchese G (2013) Minimal-access median sternotomy for aortic valve replacement. J Thorac Dis 5:S650–S653PubMedPubMedCentralGoogle Scholar
  22. Luciani N, Anselmi A, De Geest R, Martinelli L, Perisano M, Possati G (2008) Extracorporeal circulation by peripheral cannulation before redo sternotomy: indications and results. J Thorac Cardiovasc Surg 136:572–577PubMedGoogle Scholar
  23. Modi P, Hassan A, Chitwood WR Jr (2008) Minimally invasive mitral valve surgery: a systematic review and meta-analysis. Eur J Cardiothorac Surg 34:943–952PubMedGoogle Scholar
  24. Nifong LW, Rodriguez E, Chitwood WR Jr (2012) 540 consecutive robotic mitral valve repairs including concomitant atrial fibrillation cryoablation. Ann Thorac Surg 94:38–42PubMedGoogle Scholar
  25. Nishigaki K, Nishi H, Kume Y, Kitabayashi K, Miyamoto K (2005) Minimal access via lower partial sternotomy for congenital heart defects. Asian Cardiovasc Thorac Ann 13:42–46PubMedGoogle Scholar
  26. Palma G, Giordano R, Russolillo V, Cioffi S, Palumbo S, Mucerino M, Poli V, Langella G, Vosa C (2009) Anterolateral minithoracotomies for the radical correction of congenital heart diseases. Tex Heart Inst J 36:575–579PubMedPubMedCentralGoogle Scholar
  27. Perrotta S, Lentini S (2009) Ministernotomy approach for surgery of the aortic root and ascending aorta. Interact Cardiovasc Thorac Surg 9:849–858PubMedGoogle Scholar
  28. Raman J, Lehmann S, Zehr K, De Guzman BJ, Aklog L, Garrett HE, MacMahon H, Hatcher BM, Wong MS (2012) Sternal closure with rigid plate fixation versus wire closure: a randomized controlled multicenter trial. Ann Thorac Surg 94:1854–1861PubMedGoogle Scholar
  29. Ridderstolpe L, Gill H, Granfeldt H, Ahlfeldt H, Rutberg H (2001) Superficial and deep sternal wound complications: incidence, risk factors and mortality. Eur J Cardiothorac Surg 20:1168–1175PubMedGoogle Scholar
  30. Riebandt J, Haberl T, Mahr S, Rajek A, Laufer G, Schima H, Zimpfer D (2014) Off-pump HeartWare ventricular assist device implantation with outflow graft anastomosis to the left subclavian artery. Ann Thorac Surg 97:2214–2216PubMedGoogle Scholar
  31. Robicsek F, Daugherty HK, Cook JW (1977) The prevention and treatment of sternum separation following open-heart surgery. J Thorac Cardiovasc Surg 73:267–268PubMedGoogle Scholar
  32. Robicsek F, Cook JW, Rizzoni W (1998) Sternoplasty for incomplete sternum separation. J Thorac Cardiovasc Surg 116:361–362PubMedGoogle Scholar
  33. Singh K, Anderson E, Harper JG (2011) Overview and management of sternal wound infection. Semin Plast Surg 25:25–33PubMedPubMedCentralGoogle Scholar
  34. Soltesz EG, Cohn LH (2007) Minimally invasive valve surgery. Cardiol Rev 15:109–115PubMedGoogle Scholar
  35. Sudmann B, Bang G, Sudmann E (2006) Histologically verified bone wax (beeswax) granuloma after median sternotomy in 17 of 18 autopsy cases. Pathology 38:138–141PubMedGoogle Scholar
  36. Tarzia V, Carrozzini M, Bortolussi G, Buratto E, Bejko J, Comisso M, Mescola V, Penzo V, Guarino M, De Franceschi M, Pagnin C, Castoro M, Guglielmi C, Testolin L, Bottio T, Gerosa G (2014) Impact of vacuum-assisted closure therapy on outcomes of sternal wound dehiscence. Interact Cardiovasc Thorac Surg 19:70–75PubMedGoogle Scholar
  37. Tatooles AJ, Pappas PS, Gordon PJ, Slaughter MS (2004) Minimally invasive mitral valve repair using the da Vinci robotic system. Ann Thorac Surg 77:1978–1982PubMedGoogle Scholar
  38. Tavilla G, van Son JA, Verhagen AF, Lacquet LK (1991) Modified Robicsek technique for complicated sternal closure. Ann Thorac Surg 52:1179–1180PubMedGoogle Scholar
  39. Vestergaard RF, Nielsen PH, Terp KA, Søballe K, Andersen G, Hasenkam JM (2014) Effect of hemostatic material on sternal healing after cardiac surgery. Ann Thorac Surg 97:153–160PubMedGoogle Scholar
  40. Voss B, Bauernschmitt R, Will A, Krane M, Kröss R, Brockmann G, Libera P, Lange R (2008) Sternal reconstruction with titanium plates in complicated sternal dehiscence. Eur J Cardiothorac Surg 34:139–145PubMedGoogle Scholar
  41. Wang YQ, Chen RK, Ye WW, Zhong BT, He QC, Chen ZL, Li ZJ (1999) Open-heart surgery in 48 patients via a small right anterolateral thoracotomy. Tex Heart Inst J 26:124–128PubMedPubMedCentralGoogle Scholar
  42. Wiedemann DVD, Bonaros N, Laufer G, Schachner T, Kocher A (2011) Topical Use of autologous fibrin glue in high-risk CABG patients. Eur Surg 43:309–314Google Scholar
  43. Wiedemann D, Haberl T, Riebandt J, Simon P, Laufer G, Zimpfer D (2014) Ventricular assist devices – evolution of Surgical heart Failure treatment. Eur Cardiol Rev 9:54–58Google Scholar
  44. Zeitani J, Pompeo E, Nardi P, Sergiacomi G, Scognamiglio M, Chiariello G, Del Giudice C, Arganini C, Simonetti G, Chiariello L (2013) Early and long-term results of pectoralis muscle flap reconstruction versus sternal rewiring following failed sternal closure. Eur J Cardiothorac Surg 43:e144–e150PubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Austria, ein Teil von Springer Nature 2020

Authors and Affiliations

  1. 1.Klinische Abteilung für Herzchirurgie, Allgemeines Krankenhaus (AKH)Medizinische Universität WienWienÖsterreich

Personalised recommendations