Pub Date : 2020-05-19DOI: 10.5772/intechopen.87136
M. Padalino, D. Pittarello, V. Vida, G. Stellin
Surgery for congenital heart disease (CHD) has changed considerably during the last decade. Improved surgical results in patients with simple CHD and new interventional cardiology procedures have stimulated the surgeon to adopt minimally invasive techniques to reduce the patient’s surgical insult and obtain good functional and cosmetic results. As a consequence, new surgical techniques and specialized equipment for minimally invasive cardiac surgery (MICS) procedures have been developed and refined in recent years. The improving surgical outcomes in patients with CHD, the significant advances in surgical instrumentation and perfusion technology, and the broad utilization of new catheter-based interventional procedures to repair simple CHD have triggered surgeons’ interest to adopt and innovate minimally invasive approaches for CHD repair, so as to reduce patient’s surgical trauma and improve functional and cosmetic results while maintaining a high standard of clinical outcomes and possibly shortening hospitalization times. This article reports on our updated full experience and institutional protocols with MICS in children and adults with CHD.
{"title":"Minimally Invasive Approach in Surgery for Congenital Heart Disease","authors":"M. Padalino, D. Pittarello, V. Vida, G. Stellin","doi":"10.5772/intechopen.87136","DOIUrl":"https://doi.org/10.5772/intechopen.87136","url":null,"abstract":"Surgery for congenital heart disease (CHD) has changed considerably during the last decade. Improved surgical results in patients with simple CHD and new interventional cardiology procedures have stimulated the surgeon to adopt minimally invasive techniques to reduce the patient’s surgical insult and obtain good functional and cosmetic results. As a consequence, new surgical techniques and specialized equipment for minimally invasive cardiac surgery (MICS) procedures have been developed and refined in recent years. The improving surgical outcomes in patients with CHD, the significant advances in surgical instrumentation and perfusion technology, and the broad utilization of new catheter-based interventional procedures to repair simple CHD have triggered surgeons’ interest to adopt and innovate minimally invasive approaches for CHD repair, so as to reduce patient’s surgical trauma and improve functional and cosmetic results while maintaining a high standard of clinical outcomes and possibly shortening hospitalization times. This article reports on our updated full experience and institutional protocols with MICS in children and adults with CHD.","PeriodicalId":333782,"journal":{"name":"Cardiac Surgery Procedures","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114410764","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 : 2020-03-18DOI: 10.5772/intechopen.90911
M. Comisso, A. Montalto, F. Nicolò, Romina Pantanella, F. Musumeci
Heart failure is a growing disease that affects millions of people around the world. Heart transplantation is currently the therapy of choice for these patients. However, the lack of donors has forced the physician to evolve another kind of therapy such as ventricular assist device (VAD) as a bridge to transplant to com-pensate the lack of organs. Ventricular assist devices are today a successful therapy for the treatment of heart failure; the evolution of these devices and their progressive miniaturization have allowed an evolution of their implantation technique. To date, therefore, in addition to the traditional implant through sternotomy, there are more mini-invasive implant techniques. The purpose of the treaty is to describe these techniques, the implantation sites, and the benefits they can bring to patients.
{"title":"Minimally Invasive Ventricular Assist Device Surgery","authors":"M. Comisso, A. Montalto, F. Nicolò, Romina Pantanella, F. Musumeci","doi":"10.5772/intechopen.90911","DOIUrl":"https://doi.org/10.5772/intechopen.90911","url":null,"abstract":"Heart failure is a growing disease that affects millions of people around the world. Heart transplantation is currently the therapy of choice for these patients. However, the lack of donors has forced the physician to evolve another kind of therapy such as ventricular assist device (VAD) as a bridge to transplant to com-pensate the lack of organs. Ventricular assist devices are today a successful therapy for the treatment of heart failure; the evolution of these devices and their progressive miniaturization have allowed an evolution of their implantation technique. To date, therefore, in addition to the traditional implant through sternotomy, there are more mini-invasive implant techniques. The purpose of the treaty is to describe these techniques, the implantation sites, and the benefits they can bring to patients.","PeriodicalId":333782,"journal":{"name":"Cardiac Surgery Procedures","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127538755","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 : 2019-12-23DOI: 10.5772/intechopen.90560
A. Cammardella, F. Ranocchi, A. Lio, A. Pergolini, F. Nicolò, M. Comisso, V. Buffa, F. Musumeci
The introduction of transcatheter aortic valve implantation (TAVI) have changed the management of patients affected by severe aortic stenosis. Nowadays, TAVI procedure represents the treatment of choice in patients with severe AS inoperable or at high risk. MDCT is the technique of choice in preoperative planning: it provides information regarding aortic valve and vascular access. Particular attention should be paid on bicuspid valve morphology. The choice of valve is, basically, based on confidence and experience of the operator and center.
{"title":"Transcatheter Cardiac Surgery","authors":"A. Cammardella, F. Ranocchi, A. Lio, A. Pergolini, F. Nicolò, M. Comisso, V. Buffa, F. Musumeci","doi":"10.5772/intechopen.90560","DOIUrl":"https://doi.org/10.5772/intechopen.90560","url":null,"abstract":"The introduction of transcatheter aortic valve implantation (TAVI) have changed the management of patients affected by severe aortic stenosis. Nowadays, TAVI procedure represents the treatment of choice in patients with severe AS inoperable or at high risk. MDCT is the technique of choice in preoperative planning: it provides information regarding aortic valve and vascular access. Particular attention should be paid on bicuspid valve morphology. The choice of valve is, basically, based on confidence and experience of the operator and center.","PeriodicalId":333782,"journal":{"name":"Cardiac Surgery Procedures","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132747111","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 : 2019-12-13DOI: 10.5772/intechopen.86034
S. Altarabsheh, S. Deo, Y. Elgudin
Aortic root reconstruction represents one of the most complex areas of cardiac surgery as well as one of the most dynamic-major developments in understanding of the aortic root anatomy and physiology, improvements in imaging and surgical technique allowed for development and acceptance into clinical practice of several novel procedures over last couple of decades. From first aortic root replacement reported by Bentall and De Bono in 1968 to aortic root reimplantation (David procedure) and remodeling (Yacoub operation) with multiple contemporary modifications, aortic root reconstruction now is widely used in treatment of chronic aortic aneurysmal disease and acute aortic dissections alike. Basic principles of aortic root structure and function and critical operative strategies for aortic root surgery are reviewed in this chapter.
{"title":"Aortic Root Reconstruction","authors":"S. Altarabsheh, S. Deo, Y. Elgudin","doi":"10.5772/intechopen.86034","DOIUrl":"https://doi.org/10.5772/intechopen.86034","url":null,"abstract":"Aortic root reconstruction represents one of the most complex areas of cardiac surgery as well as one of the most dynamic-major developments in understanding of the aortic root anatomy and physiology, improvements in imaging and surgical technique allowed for development and acceptance into clinical practice of several novel procedures over last couple of decades. From first aortic root replacement reported by Bentall and De Bono in 1968 to aortic root reimplantation (David procedure) and remodeling (Yacoub operation) with multiple contemporary modifications, aortic root reconstruction now is widely used in treatment of chronic aortic aneurysmal disease and acute aortic dissections alike. Basic principles of aortic root structure and function and critical operative strategies for aortic root surgery are reviewed in this chapter.","PeriodicalId":333782,"journal":{"name":"Cardiac Surgery Procedures","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123504297","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 : 2019-10-03DOI: 10.5772/intechopen.86033
E. Bond, C. Valadon, M. Slaughter
Cardiac surgery has made significant progress since the advent of cardiopulmonary bypass. Arterial cannulation for bypass is a cornerstone to most cardiac procedures. Choosing an ideal cannulation site, employing peri- and intraoperative imaging, selecting an appropriate cannula, and avoiding complications are vital to success. These, along with the steps to arterial cannulation, are discussed in this chapter.
{"title":"Cannulation for Cardiopulmonary Bypass","authors":"E. Bond, C. Valadon, M. Slaughter","doi":"10.5772/intechopen.86033","DOIUrl":"https://doi.org/10.5772/intechopen.86033","url":null,"abstract":"Cardiac surgery has made significant progress since the advent of cardiopulmonary bypass. Arterial cannulation for bypass is a cornerstone to most cardiac procedures. Choosing an ideal cannulation site, employing peri- and intraoperative imaging, selecting an appropriate cannula, and avoiding complications are vital to success. These, along with the steps to arterial cannulation, are discussed in this chapter.","PeriodicalId":333782,"journal":{"name":"Cardiac Surgery Procedures","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127913063","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 : 2019-07-12DOI: 10.5772/INTECHOPEN.88102
M. Vettath, Kannan A. Vellachamy, N. Ganagadharan, M. Ravisankar, Smera Koroth, G. Raman
OPCAB was performed before the advent of heart lung machine. But with the development of stabilizers, coronary artery bypass grafting has been performed over the last two decades successfully in many centres around the world. But still 80% of bypass surgeries are done on the heart lung machine. We were one of the few teams who have been performing this OPCAB for the past 18 years. All along, we have been innovating, fabricating and developing and patenting instruments, techniques and technology to help us perform OPCAB in 100% of all our coronary patients. That too being able to reduce the mortality of bypass surgery to less than 0.5%. In this chapter, we have attempted to write down our strategy, in order to successfully perform OPCAB in all our patients, so that the coming generation can benefit from it.
{"title":"Revascularisation Strategies in OPCAB (Off Pump Coronary Artery Bypass)","authors":"M. Vettath, Kannan A. Vellachamy, N. Ganagadharan, M. Ravisankar, Smera Koroth, G. Raman","doi":"10.5772/INTECHOPEN.88102","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.88102","url":null,"abstract":"OPCAB was performed before the advent of heart lung machine. But with the development of stabilizers, coronary artery bypass grafting has been performed over the last two decades successfully in many centres around the world. But still 80% of bypass surgeries are done on the heart lung machine. We were one of the few teams who have been performing this OPCAB for the past 18 years. All along, we have been innovating, fabricating and developing and patenting instruments, techniques and technology to help us perform OPCAB in 100% of all our coronary patients. That too being able to reduce the mortality of bypass surgery to less than 0.5%. In this chapter, we have attempted to write down our strategy, in order to successfully perform OPCAB in all our patients, so that the coming generation can benefit from it.","PeriodicalId":333782,"journal":{"name":"Cardiac Surgery Procedures","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122782721","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 : 2019-04-11DOI: 10.5772/INTECHOPEN.85242
Imran Khan, Julian A Smith, N. Trehan
Since the emergence of small skin incision aortic valve surgery in the late 1990s, minimally invasive aortic valve replacement has now become a viable alternative to standard full sternotomy. The spectrum includes (a) upper hemi sternotomy (T or J shaped), (b) lower partial sternotomy, and (c) right anterior mini-thoracotomy. Potential advantages include a cosmetically appealing scar, decreased post- operative pain and bleeding, shorter ventilation time and hospital stay, and early return to active life. The operative challenges include restricted view and access to the operative field, longer aortic cross-clamp time, and cardiopulmonary bypass time. This necessitates detailed pre-operative imaging, correct selection and assessment of patients, and good communication with perfusionists and anesthetists regarding the plan of each surgery, with a solid back-up plan in case conversion to full sternotomy is required intra-operatively. In recent times, the use of suture less valves and rapid deployment bio prosthesis has dramatically reduced operative time. Here, we describe the work-up, selection criteria, key steps, and potential pitfalls of the right anterior mini-thoracotomy approach for aortic valve replacement.
{"title":"Minimally Invasive Right Anterior Mini-Thoracotomy Aortic Valve Replacement","authors":"Imran Khan, Julian A Smith, N. Trehan","doi":"10.5772/INTECHOPEN.85242","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.85242","url":null,"abstract":"Since the emergence of small skin incision aortic valve surgery in the late 1990s, minimally invasive aortic valve replacement has now become a viable alternative to standard full sternotomy. The spectrum includes (a) upper hemi sternotomy (T or J shaped), (b) lower partial sternotomy, and (c) right anterior mini-thoracotomy. Potential advantages include a cosmetically appealing scar, decreased post- operative pain and bleeding, shorter ventilation time and hospital stay, and early return to active life. The operative challenges include restricted view and access to the operative field, longer aortic cross-clamp time, and cardiopulmonary bypass time. This necessitates detailed pre-operative imaging, correct selection and assessment of patients, and good communication with perfusionists and anesthetists regarding the plan of each surgery, with a solid back-up plan in case conversion to full sternotomy is required intra-operatively. In recent times, the use of suture less valves and rapid deployment bio prosthesis has dramatically reduced operative time. Here, we describe the work-up, selection criteria, key steps, and potential pitfalls of the right anterior mini-thoracotomy approach for aortic valve replacement.","PeriodicalId":333782,"journal":{"name":"Cardiac Surgery Procedures","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133138030","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 : 2019-03-18DOI: 10.5772/INTECHOPEN.85241
T. Murashita
Robotic mitral valve repair is now routinely and safely performed all over the world. There are many literatures which showed advantages of reduced blood loss, lower risk of infection, lower risk of atrial fibrillation, shorter length of hospital stay, quicker return to normal activities, and a superior cosmetic result, compared with a conventional sternotomy. However, the introduction of new technique requires a learning curve even for expert mitral valve surgeons. There are complications specifically related to robotic mitral valve surgery, such as major vascular complications, inadequate myocardial protection, and unilateral pulmonary edema. The purpose of this chapter is to characterize the tips and pitfalls of robotic mitral valve repair and to discuss the controversial issues in the contemporary practice.
{"title":"Tips and Pitfalls in Robotic Mitral Valve Surgery","authors":"T. Murashita","doi":"10.5772/INTECHOPEN.85241","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.85241","url":null,"abstract":"Robotic mitral valve repair is now routinely and safely performed all over the world. There are many literatures which showed advantages of reduced blood loss, lower risk of infection, lower risk of atrial fibrillation, shorter length of hospital stay, quicker return to normal activities, and a superior cosmetic result, compared with a conventional sternotomy. However, the introduction of new technique requires a learning curve even for expert mitral valve surgeons. There are complications specifically related to robotic mitral valve surgery, such as major vascular complications, inadequate myocardial protection, and unilateral pulmonary edema. The purpose of this chapter is to characterize the tips and pitfalls of robotic mitral valve repair and to discuss the controversial issues in the contemporary practice.","PeriodicalId":333782,"journal":{"name":"Cardiac Surgery Procedures","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132587254","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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