A. KURMALAYEV1, E. KUATBAYEV1, LUDWIG MULLER2, YURI PYA1
1National Research Center for Cardiac Surgery”, Astana с., Republic of Kazakhstan,
2University Hospital, Innsbruck с., Austria
MINIMALLY INVASIVE ACCESS FOR OPEN HEART SURGERY, FOUR YEAR EXPERIENCE
Today in the modern medicine, the quality of life takes on great importance, what determined significantly by the cosmetic effect of the surgery. Together with it the variety of combinations of types of the constitution and the options of heart diseases requires the surgeon's ability to possess different variants of mini-approaches.
Objective. The objective of this prospective cohort observational study was to assess in-hospital mortality, bypass time and morbidity in all patients undergoing open heart surgery at our Center using a combination of port access and direct vision.
Material and methods. Starting from January 2013 and December 2016 JSC "National Resarch Cardiac Surgery Center" in Astana performed 229 operations through minimally invasive access using thoracoscopic video equipment. All of 229 patients, 158 were female, 71 were male patients. The age distribution was between 18 and 72 (the average age is 42). Mean New York Heart Association functional class 2.18±0.8). Mean ejection fraction 48±11. Pulmonary hypertension (PAP>30 mmHg, n=169 [74%]). The 82 (36%) patients underwent with atrial septal defect, 64 (30%) patients primarily underwent Mitral valve repair (14 (22%) Annuloplasty, 31 (48%) Chordoplasty, 16 (25%) Posterior leaflet resection and sliding valvuloplasty, 2 (3%) augmentation, 1 (2%) Cleft closure) and 51(22%) underwent Mitral vale replacement (26 (51%) biological and 25 (49%) mechanical valve), 3 (1,3%) patients underwent with ventricular septal defect, 16 (7%) patients underwent tricuspid valve repair and prosthesis, 3 (1,3%) ASD and tricuspid valve repair, 4 (1,7%) aortic valve replacement, 5 (2,1%) patients underwent fenestration and drainage of the pericardium. In 4 cases, of mitral valve surgery monopolar radiofrequency ablation of the left atrium
Results and discussion. There was no hospital mortality. Rethoracotomy for bleeding from intercostal arteries was made in one case. In one case we have stroke, ischemic type. Conversion to sternotomy was made in 4 patients because of adhesive pericardium. After surgery hospital stay was 4-5 days. The average time of cardiopulmonary bypass and aortic clamping was 135,4±15 min./65,8±5 minutes respectively. The number of patients complaining of mild pain in the postoperative sutures during discharge was 15 (13%).
Conclusions. Minimally invasive open-heart surgery using thoracoscopic equipment with cardiopulmonary bypass demonstrates that is a feasible method that can be performed safely and effectively, especially in the hands of experienced surgeons.
Key words: minimally invasive surgery.