Port-access minimally invasive surgery for atrial septal defects: A 10-year single-center experience in 166 patients

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Minimally invasive video-assisted cardiac surgery: operative techniques, application fields and clinical outcomes

Minimally invasive video-assisted surgery through a right minithoracotomy has become the standard surgical approach for several cardiac diseases at many major centers worldwide. In this article we review the existing literature on the subject and describe different operative techniques, application fields and clinical outcome

A simplified surgical approach for aortic valve replacement after previous coronary artery bypass grafting.

Aortic valve replacement (AVR) in patients who have undergone previous coronary artery bypass grafting (CABG) is a challenging redo surgery. We undertook this study to evaluate the early and late outcomes of patients operated upon using a simplified surgical approach. Between January 2001 and December 2005, 2238 patients underwent AVR in our institution. We reviewed retrospectively the 57 patients who had AVR following previous CABG. All patients underwent cardiopulmonary bypass with a mild-to-moderate systemic hypothermia (mean temperature: 29.7 +/- 2.5 degrees C). Patent internal thoracic artery (IMA) grafts were never dissected, controlled or clamped. A mechanical or biological prosthesis was implanted considering the patient's age. The mean cardiopulmonary bypass (CPB) time was 93 +/- 29 min (median: 80 min, range: 43-244 min) and the mean aortic cross-clamp (AoX) time was 63 +/- 18 min (median: 59 min, range: 31-125 min). The early mortality was 10.5% and the late mortality was 9.8% (mean follow-up time: 38 months). The survival was 81% at 5 years and the freedom from major cardiac events was 77%. In conclusion, from our experience, the operating quickness and a simplified approach ('open IMA technique', anterograde cardioplegia, mild-to-moderate hypothermia and minimal dissection of the mediastinal structures) represent two fundamental choices to perform this type of surgery easily, safety and with optimal results.

Surgical treatment of a pulmonary artery aneurysm

We would like to report a rare case of post-stenotic aneurysm of the pulmonary trunk and its left branch in a 51-year-old man. His cardiac disease, which was first diagnosed at the age of 4, was left untreated because of absence of symptoms and normal physical development. A CT scan, recently performed because of decrease in exercise tolerance and worsening dyspnea, showed a pulmonary artery aneurysm (52 mm x 79 mm). The echocardiography revealed a severe pulmonary commissural stenosis. Through a surgical approach the pulmonary trunk and its left branch were excised and reconstructed using a 30 mm Dacron graft; the right pulmonary branch was then reimplanted on the right side of the tube. The patient's postoperative course was uneventful. He was discharged on the seventh postoperative day and there were no adverse events or complications at 1- and 3-month follow-up