Minimally Invasive Cardiac Surgery: A Practical Guide

 

Description:

Minimally invasive cardiac surgery(MICS) is an integral component of every future cardiac surgeon’s training. There continues to be a growing global demand towards less invasive surgical techniques. Both cardiologist and cardiac surgeon form "heart teams" to provide patients with novel, minimally invasive procedures, with all their benefits. Less invasive techniques are often complex and require special knowhow and skills. This book offers an innovative approach to learning, utilizing QR code technology, which refers the reader to essential audio-visual material, which, along with the didactic text, focuses on practical aspects of minimally invasive cardiac surgery. In modern Heart Teams, and with the advent of the hybrid era, surgeons will only be able to survive if they have state-of-the-art skills in less invasive technologies, which can be incorporated in the hybrid theatre and/or trans-catheter arena. This text accompanies the surgeon along this path, and provides clinical advice and practical solutions, beyond the necessary basic knowledge. Which courses to visit, which videos to watch, which centres to join for serious training? How best to exploit public and multimedia? How to consent a patient into a MICS procedure? How to set up a MICS program or practice? In the era of value driven outcomes, and a shift towards shorter and better patient journeys, MICS is a skill that no heart surgeon can be without. Minimally Invasive Cardiac Surgery: A Practical Guide is a teaching resource, reference book and manual written by surgeons who both operate and teach the procedures described within. Provides access to online resources via QR codes Includes links to videos and the e-version of the text Acts as a gateway to a huge choice of minimally invasive cardiac surgery materials

 

Table of Contents:

 

1 Foreword/Introduction

How to get the most out of the present book

Who is the primary and secondary readership of the book?

2 History of Minimally Invasive Cardiac Surgery

History or Introduction

How It Has Been Done

Tools/Instruments and Devices

Perioperative Consideration

Alternative Approaches

Caveats and Controversies

Research, Trends and Innovation

Where and How to Learn

References

3 How to Set up a Minimally Invasive Program

History or Introduction

How to Do It/Step by Step

Tools/Instruments and Devices

Perioperative Consideration

Alternative Approaches

Caveats and Controversies

Where and How to Learn

References

4 Instrumentation and Operating Theater Set up in Minimally Invasive Cardiac Surgery

Introduction

How to Do It/Step by Step

Minimally Invasive Valve Surgery

Minimally Invasive Mitral Valve Surgery

Minimally Invasive Aortic Valve Surgery

Minimally Invasive CABG Surgery

Positioning Draping of Patient

Special Considerations

Special Instruments and Consumables

TAVI (Transfemoral and Transapical)

Femoral Cannulation Technique

Cannula Selection

Cannula Sizing

The Insertion Technique

Cannula Positioning

Cannula Securing

Open Cannulation for Endoballoon (Thruport)

Percutaneous Femoral Cannulation

Tools/Instruments and Devices

General Instrumentation

Special RETRACTORS for Minimally Invasive Mitral Valve Surgery

Special Instruments for MICS CABG Surgery

ThoraTrak Retractor

Octopus Nuvo Stabilizer and Starfish NS Positioner

Femoral Cannula

Special Instruments

Perioperative Consideration

Alternatives

Alternative Stabilizers

Aesculap FLEXHeart

Valve XS Atrium Retractor

Alternative Cannulation Technique for CPB

Axillary Artery Cannulation

SVC Cannulation

Conventional Cannulation

Peripheral Cannulation Technique

Robotic Surgery

TAVI

Caveats and Controversies

Heart Valve Surgery

MIS AVR: Approach – Upper J sternotomy vs RATS

TAVI VS SAVR

MiMVR: Mini MVR vs Robotic-Assisted

MICS CABG

References

5 Anesthesia for Minimally Invasive Cardiac Surgery

History and Introduction

How to Do It/Step by Step

Monitoring

Anesthetic Preparation

Transesophageal Echocardiography (TOE)

Ventilation Strategy

Principles Guiding Conduct of Anesthesia

Tools/Instruments and Devices

Perioperative Considerations

Pre-Anesthetic Evaluation

Positioning

Postoperative Management

Alternative Approaches

Caveats and Controversies

One-Lung Ventilation

Postoperative Pulmonary Edema

Surgical Techniques Impacting Anesthesia

Deairing of the Heart

Mitral Valve and Right Mini-Thoracotomy

Long-Acting Cardioplegia

MICS CABG

Proximal Anastomosis

Reinflating the Left Lung

Research, Trends and Innovation

Where and How to Learn

References

6 Surgical Approaches in Minimally Invasive Cardiac Surgery

History or Introduction

How to do it/Step by Step

Patient selection, preparation and positioning

Perioperative Considerations

Tools/Instruments and Devices

Alternative Approaches

Alternative caval isolation for right heart

Trans-areolar Endoscopic approach

Caveats and Controversies

Potential Complications and troubleshooting

References

7.1 The Aortic Valve: Minimally Invasive Aortic Valve Replacement. The Right Anterior Minithoracotomy

Introduction

How to Do It/Step by Step

Step 1: Patient Preparation and Exposure

Step 2: CPB installation – Cannulation, cardioplegia and LV venting

Step 3: AVR – Aortotomy, aortic valve exposure and replacement

Tools/Instruments and Devices

Medtronic ThoraTrak (MICS retractor system)

Perioperative Considerations

Alternative Approaches

Caveats and Controversies

Research, Trends and Innovation

Where and How to Learn

References

7.2 Minimally Invasive Aortic Valve Replacement: Upper “J” Sternotomy

Introduction

How to do it/Step by Step

Special Considerations

Tools/Instruments and Devices

Saw: Oscillating Saw

Aortic Cannula: EOPATM

Aortic Cross Clamp

Automated knot fastener

Perioperative Consideration

Preoperative CT scan of the patient (CT Thorax, abdomen and pelvis)

Chest Wall Deformity

Severe Calcified Ascending Aorta

Reoperations/Redo surgery

Status Post-pneumonectomy

Obesity

Post-Radiation therapy

Alternative Approaches

Manubrium-limited Sternotomy

Suprasternal AVR

Caveats and Controversies

Research, Trends and Innovation

Trans-apical TAVI

Valve-in-Valve

Where and How to Learn

Professional Education: LivaNova

EACTS Academy

National University Health System (NUHS), Singapore (ASTC)

Aortic Valve and Root Boot Camp

References

7.3 The Aortic Valve: Sutureless Valves in the Setting of MICS AVR

History and Introduction

How to do it/Step by Step

Patient selection

Perceval

Intuity Elite Valve

Tools/Instruments and Devices

Perceval S (LivaNova Group, Milan, Italy)

Intuity (Edwards Lifesciences, Irvine, CA)

Perioperative Consideration

Alternative Approaches

Caveats and Controversies

Research, Trends and Innovation

Perceval

Intuity

Perceval versus Intuity

Current evidence and future prospects

Where and How to Learn

International Valvular Surgery Study Group (IVSSG)

References

7.4 The Aortic Valve: Endoscopic Aortic Valve Surgery

History and Introduction

OT Setup and Instrumentation

How to do it/Step by Step

Cardiopulmonary Bypass (CPB)

Aortic cross clamping, cardioplegia and ventricular venting

Surgical technique

Prosthetic choice

Summarized experience

Caveats and Controversies

Where and How to Learn

Conclusions

References

8.1 Transcatheter Aortic Valve Implantation (TAVI): Transapical Transcatheter Aortic Valve Replacement

History and Introduction

How to do it/Step by Step

The Transapical Approach

Operative Technique

Tools/Instruments and Devices

Perioperative Consideration

Preoperative Assessment and Planning

Alternative Approaches

Caveats and Controversies

Research, Trends and Innovation

Where and How to Learn

References

8.2 Transfemoral Transcatheter Aortic Valve Implantation

History and Introduction

How to do it/Step by Step

Patient selection

Setup and equipment

Vascular Access

Temporary Pacemaker Placement

Aortic Root Angiogram

Delivery Sheath Insertion

Aortic Valve Crossing

Balloon Aortic Valvuloplasty (BAV)

Valve Implantation

Post-Valve implantation assessment

Tools/Instruments and Devices

Sapien 3 (Edwards Lifesciences, Irvine, CA, USA)

Evolut R (Medtronic, Fridley, MN, USA)

Lotus Edge (Boston Scientific, Marlborough, MA, USA)

Portico (Abbott, Chicago, IL, USA)

Perioperative Considerations

Preoperative assessment and screening

Echocardiogram

Cardiac catheterization

ComputeD Tomography (CT) Angiography

Associated co-morbidities

Alternative Approaches

Caveats and Controversies

Paravalvular regurgitation (PVR)

Cardiac atrioventricular conduction abnormalities

Stroke

Vascular complications

Specific caveats

Research, Trends and Innovation

Current status of TAVI

Balloon Valvuloplasty Catheter

Delivery Sheath Design

Future of transfemoral TAVI

Where and How to Learn

Medtronic TAVI course

PCR Online TAVI Atlas

ESC courses

References

8.3 Transcatheter Aortic Valve Implantation (TAVI): Alternative Approaches for Transcatheter Aortic Valve Implantation

Introduction

Alternative approaches

How to do it/Step by Step

Subclavian Transcatheter Aortic Valve Replacement (SC-TAVI)

Technique

Pros and Cons

Transaxillary Transcatheter Aortic Valve Replacement (TAX-TAVI)

Technique

Pros and Cons

Direct Aortic Transcatheter Aortic Valve Replacement (DA-TAVI)

Technique

Pros and Cons

Transcarotid Transcatheter Aortic Valve Replacement (TC-TAVI)

Technique

Pros and Cons

Transcaval Transcatheter Aortic Valve Replacement (TCA-TAVI)

Technique

Pros and Cons

Devices

Peri-procedural Considerations

Where and How to Learn

TAVI Fellowship

References

9.1 The Mitral Valve: Minimally Invasive Mitral Valve Surgery

History and Introduction

How to do it/Step by Step

Position the patient

Installing Extracorporeal Circulation

Myocardial Preservation

Exposure

Mitral valve repair technique

Tools/Instruments and Devices

Medtronic extracorporeal cannula

ThruPort IntraClude from Edwards Lifesciences

Perioperative Considerations

Caveats and Controversies

Research, Trends and Innovation

Where and How to Learn

Focus valve workshops

NUHCS Singapore Minimally Invasive Mitral Valve Programme

Cleveland Clinic minimally invasive mitral repair

References

9.2 The Mitral Valve: Alternative Approaches to Minimally Invasive Mitral Valve Surgery

History or Introduction

How to do it/Step by Step

Right Paramedian Approach

Upper Sternotomy Approach

Right Thoracotomy Approach

Tools/Instruments and Devices

MitraClipTM

Tiara Valve

Accufit Valve

TendyneTM Valve

Cardiaq Valve

Coronary Sinus-Based Percutaneous Mitral Annuloplasty

Valtech Cardioband

Mitralign

Gds Accucinch

Transapical Off-Pump Neochord Implantation

Valtech V-Chordal

Mitra-Spacer

Perioperative Consideration

Alternative Approaches

Transcatheter Mitral Valve Replacement

Percutaneous Mitral Valve Repair

Where and How to Learn

References

9.3 The Mitral Valve: Robotic Mitral Valve Surgery

History and Introduction

How to do it/Step by Step

Patient selection

Preparation

Surgical exposure and access

Cardiopulmonary bypass and myocardial protection

Operating on the mitral valve

Concluding the operation

Tools/Instruments and Devices

Da Vinci Xi system

Alexis wound protector

Endo Close™ trocar site closure device

LivaNova venous return cannulas

Optisite arterial cannulas

MiaR™ cardioplegia cannula

Chitwood Debakey aortic cross-clamp

StrykeFlow II suction irrigation pump

Perioperative Consideration

Preoperative assessment

Previous cardiac surgery

Clinical outcomes

Alternative Approaches

LEAR technique

Cardioplegia

Cross-clamp

Reoperative surgery

Caveats and Controversies

Research, Trends and Innovation

Where and How to Learn

Annals of Cardiothoracic Surgery (ACS) Video Atlas

STS workshop on Robotic Cardiac Surgery

References

9.4 The Mitral Valve: Percutaneous Mitral Valve Repair: MitraClip®

History and Introduction

Percutaneous Mitral Valve Repair using the MitraClip® System

How to do it/Step by Step

Steps

Surgical Approach

Transseptal Puncture

Anatomy of the septum

Tools/Instruments and Devices

Perioperative Consideration

Indications for MICS Procedure

Patient Selection

Contraindications

Alternative Approaches

A look to current and soon-to-come transcatheter mitral valve repair options

Caveats and Controversies

From the Cardiologist’s point of view

Transcatheter Mitral Valve Repair Today and Tomorrow

Experiences so far

Real-World Experience

Butterfly in the Heart

Beyond EVEREST

Research, Trends and Innovation

ACCESS-EU PHASE I

ACCESS-EU PHASE II

Where and How to Learn

10 Minimally Invasive Tricuspid Valve Surgery

History and Introduction

Tricuspid Regurgitation

TR at the time of left-sided heart surgery

Tricuspid Stenosis

How to do it/Step by Step

Exposure of the heart and right atrium

Cannulation and cardiopulmonary bypass

Aortic clamping and cardioplegia delivery

Main operation (TV repair or replacement)

Completion of the procedure

Redo right mini thoracotomy TV surgery (after previous pericardiotomy)

Tools/Instruments and Devices

Perioperative Consideration

Alternative Approaches

Caveats and Controversies

Research, Trends and Innovation

Where and How to Learn

References

11 Minimally Invasive Combined Heart Valve Surgery

Introduction

How to do it/Step by Step

Upper J sternotomy Approach for Double Valve Repair/Replacement (AVR+MVR)

Upper T sternotomy Approach

Right Mini-thoracotomy approach

Caval isolation

Caval occlusion

Concomitant Procedures

Tools/Instruments and Devices

External Defibrillator pads

Soft Tissue Retractor

Atrial lift system and Visor

Alternatives

Conventional full sternotomy approach

Caval Isolation

Caveats and Controversies

Combined procedures in minimally invasive versus conventional approaches

Research, Trends and Innovation

Soft Robotics in Minimally Invasive Surgery

Where and How to Learn

Minimally Invasive Techniques in Adult Cardiac Surgery (MITACS)

International Society for Minimally Invasive Cardiothoracic Surgery (ISMICS) Courses

References

12.1 The Coronaries: Minimally Invasive Coronary Artery Bypass Grafting Surgery

History or Introduction

How to do it/Step by Step

Patient positioning

Chest marking and incision

Harvesting the left internal thoracic artery (LITA)

Proximal Anastomosis

Distal Anastomoses

Chest Closure

Post-operative Care

Tools/Instruments and Devices

Perioperative Consideration

Anesthesia

Alternative Approaches

Caveats and Controversies

Research, Trends and Innovation

Where and How to Learn

References

12.2 The Coronaries: Robot Facilitated Coronary Artery Bypass Grafting

History and Introduction

How to do it/Step by Step

Patient selection

Preparation

Operative guide

Step 1: Patient placement and operative start-up

Step 2: Port insertion and robot docking

Step 3: Internal mammary artery takedown

Step 4: Utility port placement

Step 5: Precordial fat pad resection and pericardial exposure

Step 6: Peripheral vascular cannulation and application of endoclamp (endoballoon occlusion)

Step 7: Cardiopulmonary bypass

Step 8: Identification and exposure of the target vessels

Step 9: Robot-facilitated endoscopic coronary anastomosis

Step 10: Final actions

Tools/Instruments and Devices

Perioperative Consideration

Preoperative assessment and work-up

Anesthetic considerations

Postoperative care

Time demand

Alternative Approaches

Cannulation

Cardioplegia

TECAB approaches

Coronary grafting options

TECAB as hybrid coronary procedure

Caveats and Controversies

Contraindications to TECAB

Endoballoon

Extracorporeal circulation

Coronary anastomosis

Other caveats

Research, Trends and Innovation

Reduced surgical trauma advantages

Intermediate- and long-term outcomes

Predictors of success and safety, further patient aspects

Summary and future aspects

Where and How to Learn

References

12.3 Anaortic, Off-Pump, Total-Arterial Coronary Artery Bypass Grafting Surgery: The Coronaries

History and Introduction

Introduction

History of OPCAB and technical innovation

Research, Trends and Innovation

Stroke and other peri-operative complications

High-risk patients

Caveats and Controversies

Complete revascularization and long-term outcomes

How to do it/Step by Step

Anaortic OPCAB surgical technique

Tools/Instruments and Devices

Alternative Approaches

Where and How to Learn

EACTS OPCAB fellowship

EBM Beat + Youcan simulator

Summary

References

12.4 The Coronaries: Hybrid Coronary Artery Bypass Grafting Surgery

History and Introduction

How to do it/Step by Step

Tools/Instruments and Devices

Perioperative Consideration

Alternative Approaches

Caveats and Controversies

Research, Trends and Innovation

ISMICS 2014 Annual Meeting presentation

References

13 Minimally Invasive Atrial Ablation Surgery

History and Introduction

How to do it/Step by Step

Minimally invasive Cox maze procedure

Pulmonary vein isolation

Pruitt box lesion

Wolf Mini maze

PVI via right minithoracotomy

Pulmonary vein isolation and autonomic denervation

Dallas lesion set

Five box ablation

Tools/Instruments and Devices

Perioperative Considerations

Paroxysmal versus persistent AF

Minimally Invasive Surgical versus Catheter Ablation

Comorbidities

Alternative Approaches

Hybrid ablation

Thoracoscopic approach

Subxiphoid pericardioscopic approach

Transdiaphragmatic combined subxiphoid and laparoscopic approach

Concomitant minimally invasive AF ablation and mitral valve surgery

Left atrial appendage exclusion

Caveats and Controversies

Epicardial Ablation for AF

Hybrid ablation for AF

Research, Trends and Innovation

Minimally invasive Cox maze

Minimally invasive pulmonary vein isolation

Pruitt box lesion

Wolf mini maze

Pulmonary vein isolation via right minithoracotomy

Pulmonary vein isolation and autonomic denervation

Dallas lesion set

Five-Box Ablation

Hybrid Surgery for AF

Thoracoscopic Approach

Subxiphoid pericardioscopic Approach

Transdiaphragmatic combined subxiphoid and laparoscopic approach

Concomitant atrial ablation with minimally invasive mitral surgery

Conclusion

Where and How to Learn

International Society of Minimally Invasive Cardiac Surgery (ISMICS) Workshop

AtriCure Education and Training

The Journal of Innovations In Cardiac Rhythm Management

References

14.1 Aortic Surgery: Minimally Invasive Ascending Aortic Surgery

History or Introduction

Minimally invasive aortic surgery for cardiovascular surgeons

History

How to do it/Step by Step

Surgical approach

Aortic root, ascending aorta with or without proximal arch, total arch

Endovascular repair of the ascending aorta

Endovascular repair of aortic arch

Descending thoracic aorta

Thoracoabdominal aorta

Tools/Instruments and Devices

FDA-approved stent grafts

Perioperative Consideration

Indications for minimally invasive aortic surgery

Ascending aorta and aortic arch

Descending thoracic aorta

Alternative Approaches

Caveats and Controversies

Research, Trends and Innovation

Current results

Ascending aorta: Endovascular repair

Arch and descending thoracic aorta

Hybrid results

Endovascular repair

Descending thoracic aorta

Where and How to Learn

References

14.2 Aortic Surgery: Endovascular and Hybrid Approaches for Distal Arch and Descending Thoracic Aorta

History or Introduction

Distal arch aneurysms

Descending aortic aneurysms

Traumatic aortic injury

Penetrating aortic ulcers

Intramural hematoma

Coarctation of aorta

Type B aortic dissections

Other pathologies

How to do it/Step by Step

Arch Debranching

Evolution of the “Visceral Hybrid” Repair for Thoracoabdominal Aortic Pathology

General Principles

Treatment techniques

Zone 1 Pathologies

Zone 2 Pathologies

Zone 3 Pathologies

St Mary’s Visceral Hybrid Repair Technique

Alternative Approaches

Standard Approach (Transfemoral)

Conduits

Iliac/Infra-renal Abdominal Aortic Approach

Thoracic Aortic Approach

Tools/Instruments and Devices

Tools/Instruments

Devices

Standard TEVAR Devices

Custom-made TEVAR Devices

Hybrid Open TEVAR Devices

Perioperative Considerations

Device and Stock Considerations

Radiation Protection

Lumbar Spinal Drainage

Caveats and Controversies

Subclavian Artery Coverage

Chimney Techniques

References

15 Minimally Invasive Heart Failure Surgery

Introduction

Operations for Heart Failure

How to do it/Step by Step

Minimally invasive LVAD implantation

Technique

Surgical Access

Circulatory support

Operation

Special Concerns

Tools/Instruments and Devices

Acorn CoreCap

Heartware VAD (HVAD)

HeartMate III

Alternatives

Conventional Full sternotomy approach

Caveats and Controversies

Abandoned surgical options

Managing Arrhythmias in LVAD Patients

Park’s Plication Stitch for AI at the time of LVAD

Bilateral mini-thoracotomy vs separate incisions

Sternal-sparing approach

Off-Pump vs on-pump LVAD implantation

Minimally invasive vs conventional LVAD implantation

Research, Trends and Innovation

Heart failure therapy update

Where and How to Learn

ISHLT

Postgraduate Course in Heart Failure London

References

16 Epilogue

Annex

Index

 

An aparitie	26 Mar. 2021
Autor	Theo Kofidis
Dimensiuni	21.08 x 2.54 x 28.96 cm
Editura	CRC Press
Format	Hardcover
ISBN	9781498736466
Limba	Engleza
Nr pag	427