Original article
Adult cardiac
Steps Forward in Minimally Invasive Cardiac Surgery: 10-Year Experience

https://doi.org/10.1016/j.athoracsur.2019.04.109Get rights and content

Background

Minimally invasive cardiac surgery (MICS) has constantly evolved over the past years, and new technologies have been introduced. The aims of this study were to analyze the evolution of our 10-year experience in MICS and to highlight outcomes in different spans of time.

Methods

Patients undergoing MICS for mitral valve, tricuspid valve, and/or atrial septal defect or atrial masses from November 2005 to November 2015 were retrospectively analyzed. A comparative analysis was performed by identifying 2 groups: the control group (in the first time span of our experience) and the tailored group (patients who underwent surgery after a full preoperative anatomic evaluation with allocation to the proper setting).

Results

During the study period 971 patients underwent MICS. MICS procedures increased from 44% in 2006 to 96% in 2015. Subgroup analysis revealed a significant decrease in the rate of procedures performed with retrograde arterial perfusion (99.1% vs 91.7%, P < .0001), a significant increase in the rate of complex mitral valve procedures (22.4% vs 7.9%, P < .0001), and a significant decrease in the rate of stroke (from 5.2% to 1%, P < .001) in the tailored group. The logistic regression analysis showed that the tailored approach was a protective factor against neurologic complications.

Conclusions

The present study shows the considerable and attractive results of our decision-making process based on the tailored approach. The 10-year outcome analysis demonstrated a trend toward a progressive decrease in the overall rate of postoperative complications and a significant protective effect of the tailored approach on the occurrence of stroke.

Section snippets

Material and Methods

From November 2005 to November 2015, 988 consecutive patients with diagnosis of severe mitral valve (MV) disease, severe tricuspid valve disease, and/or atrial septal defect or atrial masses were enrolled for MICS at our department. Immediate intraoperative conversion to median sternotomy was required in 17 of 988 patients (1.7%) (Figure 1). Causes of conversion were related to extensive lung adhesions in 14 cases and to peripheral vascular complications before cardiopulmonary bypass onset in 3

Results

During the study period 971 patients underwent MICS at our department. Over the same period 384 patients with comparable diagnoses underwent surgery through standard median sternotomy (Figure 1).

Figure 2 shows the trend of the procedures performed through the minimally invasive and the standard sternotomy approaches over the 10-year study period. Procedures increased from 44% (68/153) in 2006 to 95% (128/135) in 2015 for the MICS group and from 56% (85/153) in 2006 to 5% (7/135) in 2015 for the

Comment

Over the last 20 years MICS has rapidly evolved because of the development of strategies involving arterial and venous cannulation, aortic clamping, and myocardial preservation.1, 2 Several settings have been described and have become routine in the surgical practice of centers all over the world; however, there is still debate in the literature regarding their role on the occurrence of major neurologic and vascular complications.3, 4, 11

This study analyzes the evolution of our 10-year

Cited by (0)

View full text