Minimally Invasive Direct Cardiac Surgery for Elderly Patients with Heart Disease_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIPing ,  YOUBin , GAOFeng , XUYi , XULi-li , LIUShuo , LIGuang

Department of Cardiac Surgery, Beijng Anzhen Hospital, The Capital Medical University, Beijing 100029, P. R. China;

Corresponding author：

YOUBin, Email: Dr_youbin@hotmail.com

Keywords：

Minimally invasive direct cardiac surgery; Elderly; Heart disease; Safety; Efficiency

DOI：

10.7507/1007-4848.20150188

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To summary the safety and efficiency of the minimally invasive direct cardiac surgery (MIDCS) approach in elderly patients with heart disease. Methods We retrospectively analyzed the clinical data of 60 patients underwent MIDCS in Beijng Anzhen Hospital between April 2010 and January 2013. There were 34 males and 26 females with mean age of 66.4±4.8 years and mean weight of 66.1±10.6 kg. Results Mean cardiopulmonary bypass time and aortic cross-clamp time was 141.2±57.2 minutes and 99.8±37.6 minutes respectively. A total of 37 patients (90.2%) recovered to beat automatically after heart ceased operation. Median mechanical ventilation time was 17.1±9.1 hours. Mean intensive care unit stay was 22.1±12.2 hours. Mean post operative hospital stay was 7.0±2.5 days. Mean incision length was 5.3±0.9 cm. Mean pericardial draining volume was 466.6±412.1 ml in the first day after operation. No transfusion occurred in 27 (45.0%) patients. Early postoperative mortality was 3.3% (2/60). There were 2 patients of reexplorations for bleeding, 1 patient of the twice tracheal intubation, 1 patient of cardiac arrest after operation, 2 patients of poor healing of skin incision, and 1 patient of injury of right phrenic nerve. When leaving hospital, 47 patients were in heart functional class Ⅰ, 8 patients in class Ⅱ, and 3 patients in class Ⅲ. Conclusion MIDCS is associated with good operative effect in the near future with superior safety and broad application range in elderly patients with heart disease.

Citation： LIPing, YOUBin, GAOFeng, XUYi, XULi-li, LIUShuo, LIGuang. Minimally Invasive Direct Cardiac Surgery for Elderly Patients with Heart Disease. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(8): 748-753. doi: 10.7507/1007-4848.20150188 Copy

1.	袁联文, 周建平. 老年心血管系统病理生理改变及常见心血管疾病围手术期处理. 中国实用外科杂志, 2008, 28(2):97-99.
2.	Rady MY, Ryan T, Starr NJ, et al. Perioperative determinants of morbidity and mortality in elderly patients undergoing cardiac surgery. Crit Care Med, 1998, 26(2):225-235.
3.	Alexander KP, Anstotrom KJ, Muhlbaier LH, et al. Outcomes of cardiac surgery in patients age>80 years:results from the National Cardiovascular Network. J Am Coll Cardiol, 2000, 35(3):731-738.
4.	DiGregorio V, Zehr KJ, Orszulak TA, et al. Results of mitral surgery in octogenarians with isolated nonrheumatic mitral regurgitation. Ann Thorac Surg, 2004, 78(3):807-813.
5.	Ariyaratnam P, Bland M, Loubani M. Risk factors and mortality associated with deep sternal wound infections following coronary bypass surgery with or without concomitant procedures in a UK population:a basis for a new risk model? Interact Cardiovasc Thorac Surg, 2010, 11(5):543-546.
6.	Risnes I, Abdelnoor M, Almdahl SM, et al. Mediastinitis after coronary artery bypass grafting risk factors and long-term survival. Ann Thorac Surg, 2010, 89(5):1502-1509.
7.	Kronzon I, Matros TG. Intraoperative echocardiography in minimally invasive cardiac surgery and novel cardiovascular surgical techniques. Am Heart Hosp J, 2004, 2(4):198-204.
8.	Kitamura T, Edwards J, Stuklis RG, et al. Minimally invasive mitral valve replacement in a patient with previous omphalocele repair and severe scoliosis. Gen Thorac Cardiovasc Surg, 2011, 59(2):117-119.
9.	Halkos ME, Vassiliades TA, Myung RJ, et al. Sternotomy versus nonsternotomy LIMA-LAD grafting for single-vessel disease. Ann Thorac Surg, 2012, 94(5):1469-1477.
10.	Kofidis T, Emmert MY, Paeschke HG, et al. Long-term followup after minimal invasive direct coronary artery bypass grafting procedure:a multi-factorial retrospective analysis at 1000 patientyears. Interact Cardiovasc Thorac Surg, 2009, 9(6):990-994.
11.	Sorm Z, Harrer J, Voborník M, et al. Early and long-term results of minimally invasive coronary artery bypass grafting in elderly patients. Kardiol Pol, 2011, 69(3):213-218.
12.	Kofidis T, Gerd Paeschke H, Lichtenberg A, et al. Factors affecting post minimally invasive direct coronary artery bypass grafting incidence of myocardial infarction, percutaneous transluminal coronary angioplasty, coronary artery bypass grafting and mortality of cardiac origin. CardioVasc Thorac Surg, 2009, 8(1):49-53.
13.	Hu SS, Xiong H, Zheng Z, et al. Midterm outcomes of simultaneous hybrid coronary artery revascularization for left main coronary artery disease. Heart Surg Forum, 2012, 15(1):E18-E22.
14.	Popov VA, Ganiukov VI, Kozyrin KA, et al. Left anterior descending bypass grafting from the anterolateral minitorakotomy. Angiol Sosud Khir, 2012, 18(2):117-122.
15.	Ju MH, Kim JB, Kim HJ, et al. Refractory coronary artery spasm after minimally invasive direct coronary artery bypass grafting. Korean J Thorac Cardiovasc Surg, 2011, 44(4):288-291.
16.	Schmitto JD, Mohr FW, Cohn LH. Minimally invasive aortic valve replacement:how does this perform in high-risk patients? Curr Opin Cardiol, 2011, 26(2):118-122.
17.	Holzhey DM, Shi W, Borger MA, et al. Minimally invasive versus sternotomy approach for mitral valve surgery in patients greater than 70 years old:a propensity-matched comparison. Ann Thorac Surg, 2011, 91(2):401-405.
18.	Galloway AC, Schwartz CF, Ribakove GH, et al. A decade of minimally invasive mitral repair:long-term outcomes. Ann Thorac Surg, 2009, 88(4):1180-1184.
19.	Santana O, Reyna J, Grana R, et al. Outcomes of minimally invasive valve surgery versus standard sternotomy in obese patients undergoing isolated valve surgery. Ann Thorac Surg, 2011, 91(2):406-410.

1. 袁联文, 周建平. 老年心血管系统病理生理改变及常见心血管疾病围手术期处理. 中国实用外科杂志, 2008, 28(2):97-99.
2. Rady MY, Ryan T, Starr NJ, et al. Perioperative determinants of morbidity and mortality in elderly patients undergoing cardiac surgery. Crit Care Med, 1998, 26(2):225-235.
3. Alexander KP, Anstotrom KJ, Muhlbaier LH, et al. Outcomes of cardiac surgery in patients age>80 years:results from the National Cardiovascular Network. J Am Coll Cardiol, 2000, 35(3):731-738.
4. DiGregorio V, Zehr KJ, Orszulak TA, et al. Results of mitral surgery in octogenarians with isolated nonrheumatic mitral regurgitation. Ann Thorac Surg, 2004, 78(3):807-813.
5. Ariyaratnam P, Bland M, Loubani M. Risk factors and mortality associated with deep sternal wound infections following coronary bypass surgery with or without concomitant procedures in a UK population:a basis for a new risk model? Interact Cardiovasc Thorac Surg, 2010, 11(5):543-546.
6. Risnes I, Abdelnoor M, Almdahl SM, et al. Mediastinitis after coronary artery bypass grafting risk factors and long-term survival. Ann Thorac Surg, 2010, 89(5):1502-1509.
7. Kronzon I, Matros TG. Intraoperative echocardiography in minimally invasive cardiac surgery and novel cardiovascular surgical techniques. Am Heart Hosp J, 2004, 2(4):198-204.
8. Kitamura T, Edwards J, Stuklis RG, et al. Minimally invasive mitral valve replacement in a patient with previous omphalocele repair and severe scoliosis. Gen Thorac Cardiovasc Surg, 2011, 59(2):117-119.
9. Halkos ME, Vassiliades TA, Myung RJ, et al. Sternotomy versus nonsternotomy LIMA-LAD grafting for single-vessel disease. Ann Thorac Surg, 2012, 94(5):1469-1477.
10. Kofidis T, Emmert MY, Paeschke HG, et al. Long-term followup after minimal invasive direct coronary artery bypass grafting procedure:a multi-factorial retrospective analysis at 1000 patientyears. Interact Cardiovasc Thorac Surg, 2009, 9(6):990-994.
11. Sorm Z, Harrer J, Voborník M, et al. Early and long-term results of minimally invasive coronary artery bypass grafting in elderly patients. Kardiol Pol, 2011, 69(3):213-218.
12. Kofidis T, Gerd Paeschke H, Lichtenberg A, et al. Factors affecting post minimally invasive direct coronary artery bypass grafting incidence of myocardial infarction, percutaneous transluminal coronary angioplasty, coronary artery bypass grafting and mortality of cardiac origin. CardioVasc Thorac Surg, 2009, 8(1):49-53.
13. Hu SS, Xiong H, Zheng Z, et al. Midterm outcomes of simultaneous hybrid coronary artery revascularization for left main coronary artery disease. Heart Surg Forum, 2012, 15(1):E18-E22.
14. Popov VA, Ganiukov VI, Kozyrin KA, et al. Left anterior descending bypass grafting from the anterolateral minitorakotomy. Angiol Sosud Khir, 2012, 18(2):117-122.
15. Ju MH, Kim JB, Kim HJ, et al. Refractory coronary artery spasm after minimally invasive direct coronary artery bypass grafting. Korean J Thorac Cardiovasc Surg, 2011, 44(4):288-291.
16. Schmitto JD, Mohr FW, Cohn LH. Minimally invasive aortic valve replacement:how does this perform in high-risk patients? Curr Opin Cardiol, 2011, 26(2):118-122.
17. Holzhey DM, Shi W, Borger MA, et al. Minimally invasive versus sternotomy approach for mitral valve surgery in patients greater than 70 years old:a propensity-matched comparison. Ann Thorac Surg, 2011, 91(2):401-405.
18. Galloway AC, Schwartz CF, Ribakove GH, et al. A decade of minimally invasive mitral repair:long-term outcomes. Ann Thorac Surg, 2009, 88(4):1180-1184.
19. Santana O, Reyna J, Grana R, et al. Outcomes of minimally invasive valve surgery versus standard sternotomy in obese patients undergoing isolated valve surgery. Ann Thorac Surg, 2011, 91(2):406-410.

Previous Article
冠状动脉CT血管造影诊断冠状动脉左前降支左心室瘘一例
Next Article
Segmentectomy versus Lobectomy for Non-small Cell Lung Cancer: A Case Control Study

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Minimally Invasive Direct Cardiac Surgery for Elderly Patients with Heart Disease

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content