Objectives: For more 10 years, Port-Access surgery has been performed at our institution. It has become the standard approach for a variety of pathologies of the heart. Few situations may be encountered in which the minimally invasive approach has to be abandoned in favour of an open procedure.
Methods: From January 2000 to June 2010, 1901 patients were scheduled for Port-Access surgery. Mitral and/or tricuspid valve disease were the predominant indications for surgery. A large majority (N=1684,88.6%) were primary interventions, the remainder redo (N=180, 9.5%) and reredo (N=37, 1.9%). Internal jugular vein and common femoral vein cannulation is routinely used, arteria inflow in acheived through the common femoral artery. An Endoclamp is used for aortic occlusion.
Results: Of all scheduled procedures, 97.7% (N=1858) were completed successfully. In 2.3% (N=43), the minimally invasive strategy was changed to conventional sternotomy. Indications were severe lungadhesions (N=25), preventing proper visualisation of the heart; cannulation problems due to severe calcified femoral vessels (N=8); anatomical problems (N=10) such as tortuosity of the femoro-iliac axes or short ascending aorta, resulting in the impossibilty to use the Endoclamp safely, or perfusion-related problems due to abnormally high perfusion pressures. Strategic changes were less frequent in the primary intervention group (N=31, 1.8%) as compared to the other groups (N=12, 5.5%)(p=0.0006). Mortality in the minimally invasive group (N=39, 2.3%) and sternotomy group (N=4, 1.8%) was similar (p=0.62)
Conclusions: A low rate of strategy change is observed in a patient group scheduled for Port-Access surgery. Outcome in both groups is similar. Only few strategic changes are required for Endoclamp-related problems.
Strategy changes in patients scheduled for port-access surgery: A reviewDossche K, Van Praet F, Deblier I, Casselman F, Degrieck I, Vermeulen Y, Vanermen H
Onze-Lieve-Vrouw Ziekenhuis, Aalst |