Extracorporeal circulation for port-access cardiac surgery

Abstract

Minimally invasive techniques for cardiac surgery are a new approach in performing some cardiac operations. Minimally invasive surgery may minimize patient discomfort, length of stay in the hospital and postoperative rehabilitation. These procedures utilize a small thoracotomy for direct visualization of the heart. However, without the use of cardiopulmonary bypass, this approach is limited to some epicardial procedures such as coronary bypass grafting, where the heart rate is pharmacologically reduced.

Port-access cardiac surgery is a new approach which provides all the benefits of minimally invasive surgery without sacrificing the advantages of cardiopulmonary bypass and myocardial preservation. Port-access cardiac surgery uses an anterior mediastinotomy and thoracic ports in conjunction with a specially designed set of endovascular catheters. These catheters provide a mode to arrest, preserve and vent the heart through an endoaortic occlusion balloon positioned in the ascending aorta, A pulmonary artery vent and coronary sinus cardioplegia catheter can also be used. These endovascular catheters, integrated with a modified heart-lung machine, provide complete cardiopulmonary support through extrathoracic cannulae inserted in a femoral artery and vein. Maintenance and monitoring of this endovascular cardiopulmonary bypass system requires the use of a kinetic pump in the venous drainage line to augment return to the heart-lung machine. Special guidelines and management parameters exist to optimize bypass with this catheter system. Using this system, port-access, minimally invasive surgery can be applied to a wider range of both epicardial and intracardiac procedures.

Get full access to this article

View all access options for this article.

References

Robinson MC , Gross DR , Zemen W , Stedje-Larsen E. Minimally invasive coronary artery bypass grafting: a new method using an anterior mediastinotomy . J Card Surg 1995; 10: 529-536 .

Benetti FJ , Ballester C. Use of thoracoscopy and a minimal thoracotomy in mammary-coronary bypass to left anterior descending artery, without extracorporeal circulation. Experience in 2 cases . J Cardiovasc Surg 1995; 36: 159-161 .

Bennetti FJ , Ballester C , Sani G. Video assisted coronary bypass surgery . J Card Surg 1995; 10: 620-625 .

Calafiore AM , DiGiammarco G , Teodori G et al. Left anterior descending coronary grafting via left anterior small thoracotomy with cardiopulmonary bypass . Ann Thorac Surg 1996; 61: 1638-1665 .

Bartlett RH. Extracorporeal life support for cardiopulmonary failure . Curr Probl Surg 1990; 27: 623-705 .

Hirschl RB , Bartlett RH. Extracorporeal membrane oxygenation support in cardiorespiratory failure . Adv Surg 1987; 21: 189-212 .

Bartlett RH. Physiology of extracorporeal life support. In: Zwischenberger JB , Bartlett RH eds. ECMO: extra corporeal cardiopulmonary support in critical care. Ann Arbor, MI: Extracorporeal Life Support Organization , 1995: 38-38.

Vogel RA , Shawl F , Tommaso C et al. Initial report of the national registry of elective cardiopulmonary bypass supported coronary angioplasty . J Am Coll Cardiol 1990; 15: 23-29 .

Hill JG , Bruhn PS , Cohen SE et al. Emergent applications of cardiopulmonary support: a multiinstitutional experience . Ann Thorac Surg 1992; 54: 699-704 .

10.

Chyatte D , Elefteriades J , Kim B. Profound hypothermia and circulatory arrest for aneurysm surgery: case report . J Neurosurg 1989; 70: 489-491 .

11.

Mongero LB , Sistino JJ , Beck J , Smith CR. Current perfusion techniques for repair of giant cerebral aneurysms using deep hypothermia and circulatory arrest . J Extracorpor Technol 1994; 26: 13-17 .

12.

Reichman TR , Joyo CI , Dembitsky WP et al. Improved patient survival after cardiac arrest using a cardiopulmonary support system . Ann Thorac Surg 1990; 49: 101-105 .

13.

Raithel SC , Swartz MT , Braun PR et al. Experience with an emergency resuscitation system . Trans Am Soc Artif Intern Organs 1989; 35: 475-477 .

14.

Peters WS. Minimally invasive cardiac surgery by cardioscopy . Australas J Cardiac Thorac Surg 1993; 2: 152-154 .

15.

Stevens JH , Burdon TA , Siegel LC et al. Port-access coronary artery bypass with cardioplegic arrest: acute and chronic canine studies . Ann Thorac Surg 1996; 62: 435-441 .

16.

Schwartz DS , Ribakove GH , Grossi EA et al. Minimally invasive cardiopulmonary bypass with cardioplegic arrest: a closed chest technique with equivalent myocardial protection . J Thorac Cardiovasc Surg 1996; 111: 556-566 .

17.

Peters WS , Burdon TA , Siegel LC et al. Port-access bilateral internal mammary artery grafting for left main coronary artery disease: Canine feasibility study . J Card Surg 1997 (in press).

18.

Pompili MF , Stevens JH , Burdon TA et al. Port-access mitral valve replacement in dogs . J Thorac Cardiovasc Surg 1996; 112: 1268-1274 .

19.

Stevens JH , Burdon TA , Peters WS et al. Port access coronary bypass grafting: a proposed surgical method . J Thorac Cardiovasc Surg 1996; 111: 567-573 .

20.

Toomasian JM , Conte JV , Reitz BA. Kinetic assisted venous drainage as an adjunct to multiple redo sternotomy. In: Toomasian JM , Kurusz M , Stafford TB eds. Case reports: clinical studies in extracorporeal circulation, Vol. 2. Houston: PREF Press , 1996: 1-10.