Research Article
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Year 2021, Volume: 4 Issue: 2, 186 - 191, 28.03.2021
https://doi.org/10.32322/jhsm.864646

Abstract

Supporting Institution

YOK

Project Number

YOK

References

  • Schmitto JD, Mokashi SA, Cohn, LH. Minimally-invasive valve surgery. J. Am. Coll. Cardiol 2010; 56: 455–62.
  • Navia JL, Cosgrove DM. Minimally Invasive Mitral Valve Operations. Ann Thorac Surg 1996; 62: 1542-4.
  • Merk DR, Lehmann S, Holzhey DM, et al. Minimal invasive aortic valve replacement surgery is associated with improved survival: a propensity-matched comparison. Eur J Cardiothorac Surg 2015; 47: 11-17.
  • Komai H, Naito Y, Fujiwara K, Noguchi Y. Cosmetic benefits of lower midline skin incision for pediatric open heartoperation. A review of 100 cases. Jpn J Thorac Cardiovasc Surg 2002; 50: 55– 8.
  • Däbritz S, Sachweh J, Walter M, Messmer BJ. Closure of atrial septal defects via limited right anterolateral thoracotomy as a minimal invasive approach in female patients. Eur J Cardiothorac Surg 1999; 15: 18 –23.
  • Yoshimura N, Yamaguchi M, Oshima Y, Oka S, Ootaki Y, Yoshida M. Repair of atrial septal defect through a right posterolateral thoracotomy: a cosmetic approach for female patients. Ann Thorac Surg 2001; 72: 2103–5.
  • Wang D, Wang Q,Yang X, Wu Q, Li Q. Mitral valve replacement through a minimal right vertical infra-axillary thoracotomy versus standard median sternotomy. Ann Thorac Surg 2009; 87: 704 – 8.
  • Lancaster LL, Mavroudis C, Rees AH, Slater AD, Ganzel BL, Gray LA Jr. Surgical approach to atrial septal defect in the female. Right thoracotomy versus sternotomy. Am Surg 1990; 56: 218-21.
  • Kaneda T, Nishino T, Saga T, Nakamoto S, Ogawa T, Satsu T. Small right vertical infra-axillary incision for minimally invasive port-access cardiac surgery: a moving window method. Interact Cardiovasc Thorac Surg 2013; 16: 544-6.
  • Lancaster LL, Mavroudis C, Rees AH. Surgical Approach to Atrial Septal Defect in Female Right thoracotomy versus sternotomy. Am Surg 1990; 56: 218-21.
  • Kirklin JW, Barret-Boyes BG (editors). Atrial septal defect and partial anomalous pulmonary venous connection. İn: Cardiac Surgery. First ed. New York: John Wiley & Sons; 1986: 463-97.
  • Attia RQ, Hickey GL, Grant SW, et al. Minimally invasive versus conventional aortic valve replacement: a propensity-matched study from the UK National Data. Innovations (Phila) 2016; 11: 15–23.
  • Schwartz DS, Ribakove GH, Grossi EA. Minimally invasive mitral valve replacement: Port-Access technique, feasibility, and myocardial functional preservation. J Thorac Cardiovasc Surg 1997; 113: 1022-31.
  • Grinda JM, Folliguet TA, Dervanian P. Right anterolateral thoracotomy for repair of atrial septal defect. Ann Thorac Surg 1996; 62: 175-8.
  • Bichell DP, Balaguer JM, Aranki SF. Axiiloaxillary cardiopulmonary bypass: a practical alternative to femorofemoral bypass. Ann Thorac Surg 1997; 64: 702-5.
  • Masuda T, Nakamura Y, Ito Y, et al. The learning curve of minimally invasive aortic valve replacement for aortic valve stenosis. Gen Thorac Cardiovasc Surg 2020; 68: 565-70.
  • Özbayburtlu M, Gültekin Y, Gemalmaz H. The assessment of the cardioprotective effectiveness of levosimendan on patients with impaired left ventricle functions and less than 40% of ejection fraction who will receive coronary artery bypass graft operation. J Health Sci Med 2020; 3: 460-65.
  • Holzhey DM, Seeburger J, Misfeld M, Borger MA, Mohr FW. Learning minimally invasive mitral valve surgery: a cumulative sum sequential probability analysis of 3895 operations from a single high-volume center. Circulation 2013; 128: 483–91.
  • Despotis GJ, Avidan MS, Hougue CV. Mechanisms and attenuation of hemostatic activation during extracorporeal circulation. Ann Thoracic Surg 2001; 72: 1821-31.
  • Tünerir B, Beşoğlu Y, Dernek S, Yavuz Y, Kural T, Aslan R. Mitral kapak replasmanında median sternotomiye alternatif bir yöntem: sağ minitorakotomi. GKDC Derg 1999; 7: 100-5.
  • Steiner ME, Despotis GJ. Transfusion algorithms and how they apply to blood conservation: the high risk cardiac surgical patient. Hematol Oncol Clin North Am 2007; 21:177-84.
  • Czer LS. Mediastinal bleeding after cardiac surgery: Etiologies, diagnostic considerations, and blood conservation methods. J Cardiothorac Anesth 1989; 3: 760-75.
  • Braxton JH, Higgins RS, Schwann TA. Reoperative mitral valve surgery via right thoracotomy: decreased blood loss and improved hemodynamics J Heart Valve Dis 1996; 5: 169-73.
  • Kalender M, Baysal AN, Dağlı M, Şahsıvar MO, Gökmengil H. Koroner arter baypas cerrahisi sırasında yapılan kan transfüzyonun hastane mortalitesi üzerine etkisi. Koşuyolu Heart J 2019; 22: 1-6.
  • Sood N, Coleman CI, Kluger J, White CM, Padala A, Baker WL. The association among blood transfusions, white blood cell count, and the frequency of postcardiothoracic surgery atrial fibrillation: a nested cohort study from the atrial fibrillation suppression trials ı, ıı, and ııı. J Cardiothorac Vasc Anesth 2009; 23: 22-7.
  • Murray KD, Pasque MK. Routine sternal closure using six overlapping Figure-of-8 wires. Ann Thorac Surg 1997; 64: 1852-4.
  • Gültekin Y, Bolat A. Bir Üniversite Hastanesi Kliniğinde Yapılan İlk 200 Açık Kalp Ameliyatı Sonuçları: Kırıkkale Üniversitesi, Tıp Fakültesi, Kalp-Damar Cerrahisi. KÜ Tıp Fak Derg 2020; 22: 348-56.
  • Wang Q, Ye XJ, Ge M, Wang DJ. Early- and long-term outcomes of cardiovascular surgery via minimal right vertical ınfra-axillary thoracotomy: a 15-year study of 1,126 patients. Scientific Reports 2018; 8: 4376-82.
  • Xu C, Pan J, Zhou Q, et al. Right vertical ınfra-axillary thoracotomy for double valve replacement. J Card Surg 2015; 30: 427–30.
  • Cohn LH. Minimally invasive aortic valve surgery: technical considerations and results with the parasternal approach. J Card Surg 1998; 13: 302-5.
  • Sündermann SH, Sromicki J, Rodriguez Cetina Biefer H, et al. Mitral valve surgery: right lateral minithoracotomy or sternotomy? A systematic review and meta-analysis. J Thorac Cardiovasc Surg 2014; 148: 1989-95.

Our results of cardiac surgery performed with a right infra axillary mini thoracotomy

Year 2021, Volume: 4 Issue: 2, 186 - 191, 28.03.2021
https://doi.org/10.32322/jhsm.864646

Abstract

Aim: The aim of the study is to share the technique and results of heart surgery performed with right infra axillary mini thoracotomy.
Materyal and Method: Between March 2013 and July 2014, 16 heart operations were performed with right infra axillary mini torocotomy incision. Patient data were analyzed retrospectively. These are 6 mitral valve replacement (MVR), 3 aortic valve replacement (AVR), 2 AVR + MVR, 2 atrial septal defect (ASD) repair, 1 myxoma excision. One of them is AVR + tricuspid ring annuloplasty operation and MVR performed due to reoperation. Radiofrequency (RF) ablation was also applied to 1 patient who underwent MVR due to atrial fibrillation.
In these operations, thoracotomy was performed through the right anterior infra axillary line. A parabolic incision of 6-8 cm was made at the 3rd intercostal space (ICA) for aortic valve interventions and at the 4th ICA level for other valve interventions. No special surgical instruments were used in the operations except standard surgical instruments. All cannulation procedures were carried out through the existing thoracotomy incision.
Results: No mortality or morbidity was observed as a result of the operations. The mean extracorporeal circulation (ECC) time was 95±11 minutes, and the mean cross clamp (CC) time was 61±9 minutes. There was an average of 380±35 cc drainage. Extubation time was 7±2.3 hours on average. All patients were taken to the service after 1±0.5 day of intensive care treatment. They were discharged from the hospital in an average of 6±1.5 days. Incision site infection was not observed in any patient. No patients were revised due to bleeding. One patient who was ablated for atrial fibrillation (AF) developed postoperative AF again. He was discharged with medical treatment and speed control.
Conclusion: In this study, we think that heart surgeries with right infraaxillary mini thoracotomy incision may be a good alternative to standard sternotomy and other minimally invasive methods in heart surgery.. With standard surgical instruments and cannulation through a single incision, not only the mitral valve but also the aortic valve, tricuspid valve and other cardiac pathologies can be easily intervened. However, very good results are obtained in patients cosmetically.

Project Number

YOK

References

  • Schmitto JD, Mokashi SA, Cohn, LH. Minimally-invasive valve surgery. J. Am. Coll. Cardiol 2010; 56: 455–62.
  • Navia JL, Cosgrove DM. Minimally Invasive Mitral Valve Operations. Ann Thorac Surg 1996; 62: 1542-4.
  • Merk DR, Lehmann S, Holzhey DM, et al. Minimal invasive aortic valve replacement surgery is associated with improved survival: a propensity-matched comparison. Eur J Cardiothorac Surg 2015; 47: 11-17.
  • Komai H, Naito Y, Fujiwara K, Noguchi Y. Cosmetic benefits of lower midline skin incision for pediatric open heartoperation. A review of 100 cases. Jpn J Thorac Cardiovasc Surg 2002; 50: 55– 8.
  • Däbritz S, Sachweh J, Walter M, Messmer BJ. Closure of atrial septal defects via limited right anterolateral thoracotomy as a minimal invasive approach in female patients. Eur J Cardiothorac Surg 1999; 15: 18 –23.
  • Yoshimura N, Yamaguchi M, Oshima Y, Oka S, Ootaki Y, Yoshida M. Repair of atrial septal defect through a right posterolateral thoracotomy: a cosmetic approach for female patients. Ann Thorac Surg 2001; 72: 2103–5.
  • Wang D, Wang Q,Yang X, Wu Q, Li Q. Mitral valve replacement through a minimal right vertical infra-axillary thoracotomy versus standard median sternotomy. Ann Thorac Surg 2009; 87: 704 – 8.
  • Lancaster LL, Mavroudis C, Rees AH, Slater AD, Ganzel BL, Gray LA Jr. Surgical approach to atrial septal defect in the female. Right thoracotomy versus sternotomy. Am Surg 1990; 56: 218-21.
  • Kaneda T, Nishino T, Saga T, Nakamoto S, Ogawa T, Satsu T. Small right vertical infra-axillary incision for minimally invasive port-access cardiac surgery: a moving window method. Interact Cardiovasc Thorac Surg 2013; 16: 544-6.
  • Lancaster LL, Mavroudis C, Rees AH. Surgical Approach to Atrial Septal Defect in Female Right thoracotomy versus sternotomy. Am Surg 1990; 56: 218-21.
  • Kirklin JW, Barret-Boyes BG (editors). Atrial septal defect and partial anomalous pulmonary venous connection. İn: Cardiac Surgery. First ed. New York: John Wiley & Sons; 1986: 463-97.
  • Attia RQ, Hickey GL, Grant SW, et al. Minimally invasive versus conventional aortic valve replacement: a propensity-matched study from the UK National Data. Innovations (Phila) 2016; 11: 15–23.
  • Schwartz DS, Ribakove GH, Grossi EA. Minimally invasive mitral valve replacement: Port-Access technique, feasibility, and myocardial functional preservation. J Thorac Cardiovasc Surg 1997; 113: 1022-31.
  • Grinda JM, Folliguet TA, Dervanian P. Right anterolateral thoracotomy for repair of atrial septal defect. Ann Thorac Surg 1996; 62: 175-8.
  • Bichell DP, Balaguer JM, Aranki SF. Axiiloaxillary cardiopulmonary bypass: a practical alternative to femorofemoral bypass. Ann Thorac Surg 1997; 64: 702-5.
  • Masuda T, Nakamura Y, Ito Y, et al. The learning curve of minimally invasive aortic valve replacement for aortic valve stenosis. Gen Thorac Cardiovasc Surg 2020; 68: 565-70.
  • Özbayburtlu M, Gültekin Y, Gemalmaz H. The assessment of the cardioprotective effectiveness of levosimendan on patients with impaired left ventricle functions and less than 40% of ejection fraction who will receive coronary artery bypass graft operation. J Health Sci Med 2020; 3: 460-65.
  • Holzhey DM, Seeburger J, Misfeld M, Borger MA, Mohr FW. Learning minimally invasive mitral valve surgery: a cumulative sum sequential probability analysis of 3895 operations from a single high-volume center. Circulation 2013; 128: 483–91.
  • Despotis GJ, Avidan MS, Hougue CV. Mechanisms and attenuation of hemostatic activation during extracorporeal circulation. Ann Thoracic Surg 2001; 72: 1821-31.
  • Tünerir B, Beşoğlu Y, Dernek S, Yavuz Y, Kural T, Aslan R. Mitral kapak replasmanında median sternotomiye alternatif bir yöntem: sağ minitorakotomi. GKDC Derg 1999; 7: 100-5.
  • Steiner ME, Despotis GJ. Transfusion algorithms and how they apply to blood conservation: the high risk cardiac surgical patient. Hematol Oncol Clin North Am 2007; 21:177-84.
  • Czer LS. Mediastinal bleeding after cardiac surgery: Etiologies, diagnostic considerations, and blood conservation methods. J Cardiothorac Anesth 1989; 3: 760-75.
  • Braxton JH, Higgins RS, Schwann TA. Reoperative mitral valve surgery via right thoracotomy: decreased blood loss and improved hemodynamics J Heart Valve Dis 1996; 5: 169-73.
  • Kalender M, Baysal AN, Dağlı M, Şahsıvar MO, Gökmengil H. Koroner arter baypas cerrahisi sırasında yapılan kan transfüzyonun hastane mortalitesi üzerine etkisi. Koşuyolu Heart J 2019; 22: 1-6.
  • Sood N, Coleman CI, Kluger J, White CM, Padala A, Baker WL. The association among blood transfusions, white blood cell count, and the frequency of postcardiothoracic surgery atrial fibrillation: a nested cohort study from the atrial fibrillation suppression trials ı, ıı, and ııı. J Cardiothorac Vasc Anesth 2009; 23: 22-7.
  • Murray KD, Pasque MK. Routine sternal closure using six overlapping Figure-of-8 wires. Ann Thorac Surg 1997; 64: 1852-4.
  • Gültekin Y, Bolat A. Bir Üniversite Hastanesi Kliniğinde Yapılan İlk 200 Açık Kalp Ameliyatı Sonuçları: Kırıkkale Üniversitesi, Tıp Fakültesi, Kalp-Damar Cerrahisi. KÜ Tıp Fak Derg 2020; 22: 348-56.
  • Wang Q, Ye XJ, Ge M, Wang DJ. Early- and long-term outcomes of cardiovascular surgery via minimal right vertical ınfra-axillary thoracotomy: a 15-year study of 1,126 patients. Scientific Reports 2018; 8: 4376-82.
  • Xu C, Pan J, Zhou Q, et al. Right vertical ınfra-axillary thoracotomy for double valve replacement. J Card Surg 2015; 30: 427–30.
  • Cohn LH. Minimally invasive aortic valve surgery: technical considerations and results with the parasternal approach. J Card Surg 1998; 13: 302-5.
  • Sündermann SH, Sromicki J, Rodriguez Cetina Biefer H, et al. Mitral valve surgery: right lateral minithoracotomy or sternotomy? A systematic review and meta-analysis. J Thorac Cardiovasc Surg 2014; 148: 1989-95.
There are 31 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Original Article
Authors

Hüseyin Gemalmaz 0000-0003-3995-3557

Yıldırım Gültekin 0000-0002-9384-0556

Project Number YOK
Publication Date March 28, 2021
Published in Issue Year 2021 Volume: 4 Issue: 2

Cite

AMA Gemalmaz H, Gültekin Y. Our results of cardiac surgery performed with a right infra axillary mini thoracotomy. J Health Sci Med / JHSM. March 2021;4(2):186-191. doi:10.32322/jhsm.864646

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