Minimally Invasive Cardiac Surgery Experiences in a District Branch Hospital

Abstract

Introduction: With the development of technology and surgical experiences, minimally invasive approaches are getting more preferable by physicians. Also these smaller incisions provide patients to have higher life quality at the postoperative periods. In this study we aim to report our minimally invasive approach experiences. Patients and Method: In our clinic 10 patients was underwent open heart surgery with minimally invasive approaches between March 2010 and January 2014. Median age was 50,5±26 years (22 – 82 years). Six of them were female (%60). Four patients have had previous open heart surgery through standard sternotomy. Ministernotomy was performed for 4 patients, 5 patients' operations were done via right anterior minithoracotomy and one patient was operated via left anterior minithoracotomy. Results: Mean operation duration was 6,8±1,8 hours (4 – 10 hours) (from anesthesia induction to wound closure with sterile sponge). Only one patient was extubated in operating theatre. Early mortality (in postoperative 30 days) was seen on only one patient. One patient was admitted to hospital with wound complication and re-hospitalized for wound care. Discussion: With developments in cardiac surgery field, many disorders are repaired via minimally invasive techniques providing exposures as good as conventional approaches. In recent years, many clinics reported their experiences at these applications with excellent results. Minimally invasive cardiac surgery does not have worse mortality rates than standard techniques. However, it enables patients to return to their own normal activities, providing them with less wound complications.Conclusion: By increasing experiences, minimally invasive cardiac surgery may be considered in those appropriate patients and particularly in patients who care about their own appearances.

Keywords

• Minimally invasive cardiac surgery, open heart surgery

Bir Bölge Dal Hastanesinin Minimal İnvazif Kalp Cerrahisi Deneyimleri

Abstract

Giriş: Teknolojik ve cerrahi alandaki gelişmelerle, minimal invazif cerrahi yaklaşımlar hekimler için daha fazla tercih edilebilir hal almışlardır. Aynı zamanda bu küçük kesiler hastaların postoperatif dönemdeki hayat kalitesini de artırmıştır. Bu çalışma ile bir bölge dal hastanesi olarak bu alandaki deneyimlerimizi bildirmek istedik.Hasta ve Metod: Mart 2010 ile Nisan 2014 arası 10 hasta hastanemizde minimal invazif yaklaşımla opere edildi. Altısı (%60) bayan olan hastaların yaş ortalaması 50,5±26 yıl (22 – 82) idi. Dört hastaya ministernotomi, 5 hastaya sağ bir hastaya sol anteriyor minitorakotomi uygulandı.Bulgular: Ortalama operasyon süresi 6,8±1,8 saat (4 – 10 saat) (anestezi indüksiyonundan yaranın steril gazlı bez ile kapatılmasına kadar geçen sure). Sadece bir hasta ameliyathanede ekstübe edildi. Erken mortalite (postoperatif ilk 30 gün) sadece 1 hastada görüldü. Bir hasta yara yeri komplikasyonu nedeniyle yeniden hospitalize edildi.Tartışma: Kardiyak cerrahi alandaki gelişmeler ile birçok bozukluk konvansiyonel yöntemler kadar iyi görüş sağlayan minimal invazif tekniklerle ameliyat edilebilmektedir. Son yıllarda birçok klinik bu alanda gayet güzel sonuçlarını yayınlamışlardır. Sonuçlar da gösteriyor ki, minimal invazif yaklaşım standart tekniklerden daha kötü sonuçları olmamakla beraber hastaların normal yaşam aktivitelerine dönüşlerini kolaylaştırıp, yara yeri komplikasyonlarını da azaltmaktadır. Sonuç: Artan deneyimlerle beraber özellikle dış görünümüne önem veren uygun hastalarda minimal invazif yaklaşımlar akılda bulundurulmalıdır.

Keywords

• Minimal invazif kalp cerrahisi, açık kalp cerrahisi

References

1. 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.
2. Gilmanov D, Bevilacqua S, Murzi M, Cerillo AG, Gasbarri T, Kallushi E, et al. Minimally invasive and conventional aortic valve replacement: a propensity score analysis. Ann Thorac Surg 2013;96:837-43.
3. Erentuğ V, Sareyüpoğlu B, Göksedef D, Kırali K, Güler M, İpek G, et al. Closure of atrial septal defects with anterior thoracotomy in female patients. Turk Gogus Kalp Dama 2005;13:99-102.
4. Totaro P, Carlini S, Pozzi M, Pagani F, Zattera G, D’Armini AM, et al. Minimally invasive approach for complex cardiac surgery procedures. Ann Thorac Surg 2009;88:462-6.
5. Uymaz B, Sezer G, Köksal Coşkun P, Tarcan O, Ozleme S, Aybek T. Clinical outcome, pain perception and activities of daily life after minimally invasive coronary artery bypass grafting. Anadolu Kardiyol Derg 2014;14:172-7.
6. Smit PJ, Shariff MA, Nabagiez JP, Khan MA, Sadel SM, McGinn JT Jr. Experience with a minimally invasive approach to combined valve surgery and coronary artery bypass grafting through bilateral thoracotomies. Heart Surg Forum 2013;16:125-31.
7. Diegeler A, Walther T, Metz S, Falk V, Krakor R, Autschbach R, et al. Comparison of MIDCAP versus conventional CABG surgery regarding pain and quality of life. Heart Surg Forum 1999;2:290-6.
8. Fujiwara K, Naito Y, Komai H. (Lower mid-line skin incision and minimal sternotomy in pediatric open heart surgery-an alternative cosmetic approach). Nihon Geka Gakkai Zasshi 1998;99:837-41.