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Minimally Invasive Aortic Valve Surgery
Saturday, May 24, 2008
|To help reduce the potential for air emboli, a cannula is sewn to the wound edge and the field flooded with CO2 at liters per minute. This displaces oxygen and nitrogen and any bubbles of CO2 are rapidly absorbed.|
|The aorta is cross-clamped and an oblique incision is made which is extended into the noncoronary sinus.|
|The valve to be replaced is excised. Sutures are placed through the annulus and subsequently through the aortic prosthesis and tied.|
|At the completion of the procedure the patient is decannulated. The atrial and two ventricular wires are placed and the sternum closed with monofilament wire. The wound is closed in layers.|
|In order to adequately drain the mediastinum and right pleura, a right angle chest tube is placed that lies on top of the diaphragm and a straight tube inserted directly into the pericardial sac.|
- This approach represents a progression thoughts based on different incisions used. Having used a parasternal and transverse sternotomy incision, this seems to be the most useful with the best healing.
- Small flexible cannulae should be used to minimize obstruction of the operative field.
- If the venous cannulae are attached to the cardiotomy suction set at (-80mmHg) smaller cannulae can be used with better venous drainage and prevention of an airlock in case of air aspiration.
- Chitwood Jr WR, Elbery JR, Chapman WHH et al, Video-assisted minimally invasive mitral valve surgery: The "Micro-Mitral" operation. J Thorac Cardiovasc Surg 1997;113:413-4.
- Benetti FJ, Rizzard JL, Pire L and Polanco A, Mitral Replacement under video assistance through a minithoracotomy. Ann Thorac Surg 1997;63:1150-2.
- Carpentier A, Loulmet D, Carpentier A et al, First open heart operation (Mitral valvuloplasy) under videosurgery through a minithoracotomy. C.R. Academie of Sciences, Paris 1996;319-219-23.
- Chiwood Jr WR, Elberry JR, Chapman WHH et al. Video-assisted Minimally invasive mitral valve surgery. The "Micro-Mitral" operation J. Thorac Cardiovasc Surg 1997;113:413-4.
- Cosgrove DM and Sabik JF, Minimally invasive approach for aortic valve operations. Ann Thorac Surg 1996;62:596-7.
- Cosgrove DM, Sabik JF and Navia J. Minimally invasive valve surgery. Ann Thorac Surg 1997 [in press].
- Gundry SR, Shattuck OH, Rassouk AJ, del Rio MJ, et al. Cardiac operations in adults and children via ministernotomy facile minimally invasive aortic, valve replacement. Ann Thorac 1997 [in press].
- Lin PJ, Chang CH, Chu JJ, Liu HP, et al, Video-assisted mitral valve operations. Ann Thorac Surg 1996;61:1781-7.
- Minale C, Reifschneider HJ, Schmitz E and Uckmann FP, Single access for minimally aortic valve replacement. Ann Thorac Surg 1997;64:120-3.
- Navia JL and Cosgrove DM, Minimally invasive mitral valve operations. Ann Thorac Surg 1996;62:1542-4.
- Schwartz DS, Ribakove GH, Grossi EA, Stevens JH, et al, Minimally invasive cardiopulmonary bypass with cardioplegic arrest: A closed chest technique with equivalent myocardial protection. J Thorac Cardiovasc Surg 1996;111:556-66.