وصف
Surgery to repair the mitral valve is a minimally invasive procedure. Between the upper left heart chamber (left atrium) and lower left heart chamber (left ventricle), the mitral valve maintains blood flow in the proper direction. If the patient's mitral valve isn't functioning properly, they need to have it repaired. The surgeon will make one or more tiny incisions in the chest to introduce tiny surgical instruments and cameras if they use a surgical robot to perform the minimally invasive mitral valve replacement. Compared to conventional open-heart surgery, which requires a lengthy incision down the front of the chest, this method is less intrusive.
ملخص
- Minimally invasive cardiac surgery (MICS) is performed through small incisions using specialized instruments, avoiding full sternotomy. It can be epicardial (on the heart's surface without opening it) or endocardial (involving opening the heart). Carpenter and Lait classified MICS into four levels based on incision size, with mini-AVR and MVR falling under level two. A typical MICS setup involves a specific arrangement of the anesthesiologist, surgeons, and support staff around the patient.
- Conventional cardiac surgery involves full sternotomy, providing complete access to the heart. While advantageous for complex cases and offering control during emergencies, it results in more pain, blood loss, longer hospital stays, and wound complications. MICS offers cosmetic benefits, reduced pain, faster healing, less blood loss, and shorter hospital and ICU stays, but it's technically demanding, requires specialized training, and isn't suitable for all patients.
- Contraindications for MICS include obesity, previous lung surgeries, LV dysfunction, coronary artery issues, multiple surgeries, and high RVSP. Redo MVR is also generally not preferred using MICS. Right anterior thoracotomy allows for mini-MVR, tricuspid surgeries, ASD closure, and tumor removals. Left anterior thoracotomy is used for minimally invasive CABG, with central cannulation preferred over femoral due to fewer complications.
- Femoral artery cannulation was initially preferred, but central cannulation has become more common due to fewer peripheral vascular complications. Proper patient positioning involves right shoulder propping at 30-40 degrees. Pericardium should be opened 2-3 cm above the phrenic nerve to avoid damage.
- Patient selection is crucial for successful MICS. Start with simple valve cases without concomitant procedures and those with a large left atrium. During the mitral valve replacement, clamping the atrial appendage and bringing it down gives better aortic exposure. Be cautious when clamping the aorta to avoid damaging it. During valve excision it's preferred to leave a small rim of the leaflet to aid stitch placement.
نموذج شهادة
حول المتحدثين
Dr. Aakash Joshi
Cardiothoracic & Vascular Surgeon, UN Mehta Institute of Cardiology & Research Center, Ahmedabad
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