Minimally Invasive Valve Surgery
Minimally Invasive Cardiac Surgery
• Indications • Techniques • Results
Minimally Invasive Cardiac Surgery
• Indications • Techniques • Results
Indications •
Isolated valvular disease
• Aortic stenosis/regurgitations • Mitral regurgitations/stenosis • Tricuspid regurgitation •
Multivalvular disease
Contradindications •
Coronary artery disease
•
Chest deformities – pectus excavatum
•
Severe peripheral vascular disease
Minimally Invasive Cardiac Surgery
• Indications • Techniques • Results
Aortic Valve Surgery
Minimally Invasive AVR •
Indicated for:
• Isolated aortic stenosis • Isolated aortic regurgitation • Aortic stenosis and ascending aortic aneurysm
• Isolated ascending aortic aneurysm • Isolated reoperative aortic valve replacement
Minimally Invasive AVR Operative Times 100
P=.001
C-P Bypass Aortic Occlusion
80
Mins.
60 40 20 0
1996 1997 1998 1999 2000 2001 2002 2003
Minimally Invasive AVR Mortality
0.8 %
Trans-Apical Aortic Valve ImPlantation (TAAP) Approach
•
The apex of the heart is accessed via a small left anterior thoracotomy
•
Indicated for patients with PVD and / or multi valve disease Anterior Thoracotomy
Valve Deployment •
Rapid ventricular pacing initiated to ↓ cardiac output to prevent distal migration of the valve
•
Valve is then deployed by balloon inflation
Final Position •
The valve sits within native annulus and the stenotic leaflets, below the coronary ostia.
•
Radial expansion and friction prevent distal migration of the expanded valve
Mitral Valve Surgery
Mitral Surgery
•
Partial sternotomy
•
Rt. Thoracotomy
•
Robotically-assisted
Mitral Surgery • • •
Partial sternotomy Rt. Thoracotomy Robotically-assisted One size does NOT fit all patients
Mitral Surgery • • •
Partial sternotomy Rt. Thoracotomy Robotically - assisted One size does NOT fit all patients One size does NOT fit all surgeons
Partial Sternotomy
Right Thoracotomy
Robotics
Robotic Surgical Instrumentation •
State-of-the-art robotic technology – intuitive motion control of surgical instruments
•
Surgeon in control
•
Assistant has direct access
The surgeon directs the instruments •
Surgeon directs the instrument movements using Console controls
•
Motion of the surgeon’s hand translates in the motion of articulated surgical instruments
Robotically-Assisted Mitral Valve Repair
Atriotomy
Valve Inspection
Leaflet Repair
Annuloplasty
Left atrial closure
Postoperative Echo
Minimally Invasive Cardiac Surgery
• Indications • Techniques • Results
Robotic MV repair 2006 - 2012
1000
Mortality
0%
Mitral Valve Repair
99.3 %
Conclusion •
Minimally invasive approaches should be considered for all patients with isolated valvular disease
Thank You