Pub Date : 2013-05-25DOI: 10.3760/CMA.J.ISSN.1001-4497.2013.05.012
Xing-hai Hao, F. Wan, Hong Zhao, Z. Cui, Qiang Liu, Zhiming Song
Objective To analysis of preoperative preparation,operation,character,advantage and deficiency of two non-robotic TIMAH approach in MIDCAB,and to observe the short-term follow up result.Methods 7 male CAD patients with classic unstable angina pectoris,the age ranged from 52 to 75 years,average (63.8 ± 8.5) years,underwent TIMAH and MIDCAB,in which 6 single LAD disease patients and one patient for reoperation with saphenous vein graft (SVG) graft failure to LAD and progressive obtuse marginal(OM) coronary artery disease.These patients were intubated with a double-lumen endotracheal tube,and one-lung ventilation were used to facilitate the procedure.In the approach of two incisions TIMAH for 4 patients,the thoracoscope was placed at the third intercostals space(ICS) on the anterior axillary line,and LIMA was dissected with endo-instruments placed from the two angles of mini-thoracotomy at fifth ICS on the midclavicular line.In the approach of three incisions TIMAH for 3 patients,LIMA was dissected with endo-instruments placed from two ports at the fourth ICS on the anterior axillary line and at the fifth ICS on the midclavicular line,and the thoracoscope was placed at the second or third intercostals space (ICS) on the anterior axillary line.Anastomosis of LIMA and LAD followed through mini-thoracotomy at fifth ICS with the heart stabilizer after TIMAH.SVG graft was used from LIMA to OM in the reoperation patient.Results All patients underwent TIMAH and MIDCAB safely without transferece to stenotomy,only one LIMA was extended with 2 cm SVG for injure at the distal.In 6 single vessel disease patients the length of mini-thoracotomy incision was (6.0 ± 0.9) cm,TIMAH time was (112 ±18) min,operation time was (293 ± 75) min,bleeding volume was (233 ± 52) ml,endotracheal tube time was (14.2 ± 10.7) h,ICU time was (1.8 ±0.4) d and hospital stay time was (10.1 ±6.7) d.All patients were uneventful discharged and with no recurrence of cardiac symptoms in short-term follow up.Conclusion TIMAH can perform safely in both approaches for LIMA prepare to MIDCAB as described before.The minimally invasive procedure need not enlarge incision for LIMA harvesting with good short term results. Key words: Thoracoscopes ; Coronary artery bypass, off-pump ; Surgical procedures, minimally
{"title":"Thoracoscopic internal mammary artery harvesting approach in MIDCAB","authors":"Xing-hai Hao, F. Wan, Hong Zhao, Z. Cui, Qiang Liu, Zhiming Song","doi":"10.3760/CMA.J.ISSN.1001-4497.2013.05.012","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-4497.2013.05.012","url":null,"abstract":"Objective To analysis of preoperative preparation,operation,character,advantage and deficiency of two non-robotic TIMAH approach in MIDCAB,and to observe the short-term follow up result.Methods 7 male CAD patients with classic unstable angina pectoris,the age ranged from 52 to 75 years,average (63.8 ± 8.5) years,underwent TIMAH and MIDCAB,in which 6 single LAD disease patients and one patient for reoperation with saphenous vein graft (SVG) graft failure to LAD and progressive obtuse marginal(OM) coronary artery disease.These patients were intubated with a double-lumen endotracheal tube,and one-lung ventilation were used to facilitate the procedure.In the approach of two incisions TIMAH for 4 patients,the thoracoscope was placed at the third intercostals space(ICS) on the anterior axillary line,and LIMA was dissected with endo-instruments placed from the two angles of mini-thoracotomy at fifth ICS on the midclavicular line.In the approach of three incisions TIMAH for 3 patients,LIMA was dissected with endo-instruments placed from two ports at the fourth ICS on the anterior axillary line and at the fifth ICS on the midclavicular line,and the thoracoscope was placed at the second or third intercostals space (ICS) on the anterior axillary line.Anastomosis of LIMA and LAD followed through mini-thoracotomy at fifth ICS with the heart stabilizer after TIMAH.SVG graft was used from LIMA to OM in the reoperation patient.Results All patients underwent TIMAH and MIDCAB safely without transferece to stenotomy,only one LIMA was extended with 2 cm SVG for injure at the distal.In 6 single vessel disease patients the length of mini-thoracotomy incision was (6.0 ± 0.9) cm,TIMAH time was (112 ±18) min,operation time was (293 ± 75) min,bleeding volume was (233 ± 52) ml,endotracheal tube time was (14.2 ± 10.7) h,ICU time was (1.8 ±0.4) d and hospital stay time was (10.1 ±6.7) d.All patients were uneventful discharged and with no recurrence of cardiac symptoms in short-term follow up.Conclusion TIMAH can perform safely in both approaches for LIMA prepare to MIDCAB as described before.The minimally invasive procedure need not enlarge incision for LIMA harvesting with good short term results. \u0000 \u0000Key words: \u0000Thoracoscopes ; Coronary artery bypass, off-pump ; Surgical procedures, minimally","PeriodicalId":10185,"journal":{"name":"Chinese Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2013-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69751379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2011-07-25DOI: 10.3760/CMA.J.ISSN.1001-4497.2011.07.005
Ming Yang, Chong-qing Gao, C. Xiao, Gang Wang, Jia-li Wang
Objective To Summary the first 40 cases underwent robotic atrial septal defect (ASD) closure or atrial septal defect closure combined bicuspid valve plasty (TVP) using "da Vinci S" surgical System on beating heart. Methods 40 cases of atrial septal defect or combined sever tricuspid valve regurgitation were repaired using "da Vinic S" surgical system on beating heart from March 2009 to December 2010 in cardiovascular department of PLA general hospital. The average age was (38 ± 13) yeas old. 23 cases were female and 17 cases were male. All patients were ostium atrial septal defect with or without pulmonary hypertension. The atrial defect diameter was 1.5 -3.5 cm, and the mean diameter was(2. 8 ±1.3)cm. 9 patients had sever tricuspid valve regurgitation. Without sternotomy, the extracorporeal circulation was established through groin artery,groin vein and internal jugular vein cannulation with the guidance of transeophageal echocardiography. 3 ports of 8 mm and 1 working port of 2 cm were made in the right chest wall. After "da Vinci S" syetem was set up, with the assistant of bed-side surgeon, the surgeon completed the atrial septal defect closure or combined tricuspid valve plasty in the surgeon console with three dimensions visualization. During the operation, without cardioplegia administrated and aortic occlusion, the procedure was completed through right atriotomy. The pleural space was insufflated with carbon dioxide to avoid the air embolism. The direct suturing was used in 22 cases and pericardial patch were used in 18 cases. 9 patients accepted concurrent De Vega tricuspid valve plasty. The transesophageal echocardiography were used to evaluate the result of atrial defect closure or tricuspid valve repair. The operation time, robotic using time and cardiopulmonary time were compared with totally robotic atrial defect repair in arrested heart. Results All cases were accomplished successfully without complication. There was no residual shunt and air embolism. The operation time, robotic using time and cardiopulmonary time were less than the arrested group. Conclusion Robotic atrial septal defect closure or combined tricuspid valve repair on beating heart can avoid aortic ocllusion and can be utilized effectively and safely. Key words: Atrial septal defect; Cardiac Surgical procedures; Minimally invasive; Robotics
{"title":"Totally robotic atrial septal defect closure using da vinci S surgical system on beating heart","authors":"Ming Yang, Chong-qing Gao, C. Xiao, Gang Wang, Jia-li Wang","doi":"10.3760/CMA.J.ISSN.1001-4497.2011.07.005","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-4497.2011.07.005","url":null,"abstract":"Objective To Summary the first 40 cases underwent robotic atrial septal defect (ASD) closure or atrial septal defect closure combined bicuspid valve plasty (TVP) using \"da Vinci S\" surgical System on beating heart. Methods 40 cases of atrial septal defect or combined sever tricuspid valve regurgitation were repaired using \"da Vinic S\" surgical system on beating heart from March 2009 to December 2010 in cardiovascular department of PLA general hospital. The average age was (38 ± 13) yeas old. 23 cases were female and 17 cases were male. All patients were ostium atrial septal defect with or without pulmonary hypertension. The atrial defect diameter was 1.5 -3.5 cm, and the mean diameter was(2. 8 ±1.3)cm. 9 patients had sever tricuspid valve regurgitation. Without sternotomy, the extracorporeal circulation was established through groin artery,groin vein and internal jugular vein cannulation with the guidance of transeophageal echocardiography. 3 ports of 8 mm and 1 working port of 2 cm were made in the right chest wall. After \"da Vinci S\" syetem was set up, with the assistant of bed-side surgeon, the surgeon completed the atrial septal defect closure or combined tricuspid valve plasty in the surgeon console with three dimensions visualization. During the operation, without cardioplegia administrated and aortic occlusion, the procedure was completed through right atriotomy. The pleural space was insufflated with carbon dioxide to avoid the air embolism. The direct suturing was used in 22 cases and pericardial patch were used in 18 cases. 9 patients accepted concurrent De Vega tricuspid valve plasty. The transesophageal echocardiography were used to evaluate the result of atrial defect closure or tricuspid valve repair. The operation time, robotic using time and cardiopulmonary time were compared with totally robotic atrial defect repair in arrested heart. Results All cases were accomplished successfully without complication. There was no residual shunt and air embolism. The operation time, robotic using time and cardiopulmonary time were less than the arrested group. Conclusion Robotic atrial septal defect closure or combined tricuspid valve repair on beating heart can avoid aortic ocllusion and can be utilized effectively and safely. \u0000 \u0000Key words: \u0000Atrial septal defect; Cardiac Surgical procedures; Minimally invasive; Robotics","PeriodicalId":10185,"journal":{"name":"Chinese Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69751310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2007-06-18DOI: 10.3760/CMA.J.ISSN.1001-4497.2007.03.011
Meng Xu
Objectve To analyze the risk factors of perioperative mortality after mitral leaflet repair retrospectively.Methods Data of 542 patients undergoing mitral leaflet repair in An Zhen Hospital between March 1985 and June 2006 were collected.Preop- erative and operative variates were evaluated by univariate and multivariate logistic stepwise regression analysis,Results 20 patients (3.7 %)died postoperatively within 30 days.Univariate risk factors included age,preoperative congestive heart failure,preoperative left ventricular end-systolic diameter,preoperative left ventricular ejection fraction,NYHA class Ⅲ-Ⅳ,CPB time,Cross-clamp time and mltral leaflet repair concomitant coronary artery bypass graft(CABG).Logistic stepwise regression analysis showed that preopera- tive congestive heart failure,preoperative left ventrieular ejection fraction and mitral leaflet repair concomitant CABG were independent risk factors of mortality after mitral leaflet repair.Conclusion Conclusion It suggests that preoperative congestive heart failure,preo- perative left ventricular ejection fraction and mitral leaflet repair concomitant CABG are independent risk factors for mortality after mi- tral leaflet repair.
{"title":"Risk factors of perioperative mortality after mitral leaflet repair","authors":"Meng Xu","doi":"10.3760/CMA.J.ISSN.1001-4497.2007.03.011","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-4497.2007.03.011","url":null,"abstract":"Objectve To analyze the risk factors of perioperative mortality after mitral leaflet repair retrospectively.Methods Data of 542 patients undergoing mitral leaflet repair in An Zhen Hospital between March 1985 and June 2006 were collected.Preop- erative and operative variates were evaluated by univariate and multivariate logistic stepwise regression analysis,Results 20 patients (3.7 %)died postoperatively within 30 days.Univariate risk factors included age,preoperative congestive heart failure,preoperative left ventricular end-systolic diameter,preoperative left ventricular ejection fraction,NYHA class Ⅲ-Ⅳ,CPB time,Cross-clamp time and mltral leaflet repair concomitant coronary artery bypass graft(CABG).Logistic stepwise regression analysis showed that preopera- tive congestive heart failure,preoperative left ventrieular ejection fraction and mitral leaflet repair concomitant CABG were independent risk factors of mortality after mitral leaflet repair.Conclusion Conclusion It suggests that preoperative congestive heart failure,preo- perative left ventricular ejection fraction and mitral leaflet repair concomitant CABG are independent risk factors for mortality after mi- tral leaflet repair.","PeriodicalId":10185,"journal":{"name":"Chinese Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2007-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69751673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2005-12-18DOI: 10.3760/CMA.J.ISSN.1001-4497.2005.06.005
Zhang Hair
Objective To review the experience of diagnosis and treatment of pulmonary sling. Methods Between May 1999 and January 2005,8 patients affected by pulmonary sling were admitted in our hospital. Seven patients were surgically treated. The clinical features, diagnostic means and surgical treatment methods of pulmonary sling were discussed. Results There was no operative mortality and after 3 months to 5 years follow-up, all patients are doing well. Conclusion The outcome of surgical treatment of pulmonary sling is acceptable and surgical interfering should be done as soon as diagnose is made. The surgical techniques include left pulmonary artery reconstruction and enlargement of stenotic tracheal.
{"title":"Diagnosis and surgical treatment of Pulmonary sling","authors":"Zhang Hair","doi":"10.3760/CMA.J.ISSN.1001-4497.2005.06.005","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-4497.2005.06.005","url":null,"abstract":"Objective To review the experience of diagnosis and treatment of pulmonary sling. Methods Between May 1999 and January 2005,8 patients affected by pulmonary sling were admitted in our hospital. Seven patients were surgically treated. The clinical features, diagnostic means and surgical treatment methods of pulmonary sling were discussed. Results There was no operative mortality and after 3 months to 5 years follow-up, all patients are doing well. Conclusion The outcome of surgical treatment of pulmonary sling is acceptable and surgical interfering should be done as soon as diagnose is made. The surgical techniques include left pulmonary artery reconstruction and enlargement of stenotic tracheal.","PeriodicalId":10185,"journal":{"name":"Chinese Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2005-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83126899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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