Eastern Cardiothoracic Surgical Society

Initial Experience with a Combined Bilateral Mini Thoractomy Approach for Valve and Coronary Artery Bypass Surgery
Mark Anderson, Sal Shah, Theresa Baker, Jennifer Arnold,  Albert Einstein Healthcare Network, Philadelphia, PA


OBJECTIVE: Minimally invasive cardiac surgery is commonplace. Patients with CAD had PCI before MICS. Occasionally, this is not feasible. As a result, we combined our mini valve and coronary bypass procedures.

METHODS:Patients undergoing a combined MICS procedure had their charts reviewed.

RESULTS: 12 patients were identified (8 male). Mean age 75 +/- 7. 5 years. Procedures included 8 AVR / CABG and 4 MVR / CABG. The LIMA was utilized in 8 cases and SVG in 4 (AVR). The LAD was grafted in 11 and the PDA in 1 (SVG). The procedures were carried out via bilateral mini thoracotomies with the exception of the PDA graft, which was done via a right subcostal approach. All distal were done on an arrested heart. 2 proximals were done with the aorta crossclamped and 2 with the aid of the HeartString device. Mean clamp time was 80 +/- 9 mins and surgical time was 151 +/-11 mins. Intubation time was 2.9 +/- 2.1 hours. Chest tube drainage was 519 +/- 156 mls. ICU stay was 27 +/- 11.6 hours and hospital LOS 6.3 +/-2.6 days. There were no post operative deaths. Morbidity included 1 pleural effusion requiring drainage.

CONCLUSIONS: Our initial experience with the combined minimally invasive valve / coronary artery bypass procedure suggests that it is feasible and safe. However, a more in depth analysis of the outcomes / benefits of the procedure as well as a comparison to traditional techniques is required. Given the initial results, further study seems warranted.