Journal: Innovations

Abbreviation

Innovations

Publisher

SAGE

Journal Volumes

ISSN

1556-9845
1559-0879

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Filters

2019 - 201912020 - 20235
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Publications 1 - 6 of 6
  • Uncertainty Resolved?
    Item type: Other Journal Item
    Falk, Volkmar (2021)
    Innovations
  • Single-Center Experience With a Self-Expandable Venous Cannula During Minimally Invasive Cardiac Surgery
    Item type: Journal Article
    Van Praet, Karel M.; Kofler, Markus; Meyer, Alexander; et al. (2022)
    Innovations
    Objective: Venous drainage is often problematic in minimally invasive cardiac surgery (MICS). Here, we describe our experience with a self-expandable stent cannula designed to optimize venous drainage. Methods: The smart canula (R) was used in 58 consecutive patients undergoing MICS for mitral valve disease (n = 40), left atrial myxoma (n = 3), left ventricular outflow tract obstruction (n = 1), and aortic valve replacement via a right anterior minithoracotomy (n = 14) procedures. The venous cannula was placed under transesophageal echocardiography guidance to reach the superior vena cava. Vacuum-assisted venous drainage (between -20 and -35 mm Hg) was used to reach a target flow index of 2.2 L/min/m(2) at a core temperature of 34 degrees C using a goal-directed perfusion strategy aimed at a minimum DO2 of 272 mL/min/m(2). Cardiopulmonary bypass (CPB) parameters were recorded, and hemolysis-related parameters were analyzed on postoperative days 1 to 7. Results: Mean body surface area and median body mass index were 1.9 +/- 0.2 m(2) and 25.2 (23.4, 30.2) kg/m(2). Mean CPB and median cross-clamping times were 107.7 +/- 24.4 min and 64.5 (53, 75.8) min, and median CPB flow during cardioplegic arrest was 4 (3.6, 4.2) L/min (median cardiac index 2.1 [2, 2.2] L/min/m(2)). Venous drainage was considered sufficient by the surgeon in all cases, and insertion and removal were uncomplicated. Mean SvO(2) during CPB was 80.2% +/- 5.5%, and median peak lactate was 10 (8, 14) mg/dL, indicating sufficient perfusion. Mean venous negative drainage pressure during cross-clamping was 27.2 +/- 12.3 mm Hg. Platelets dropped by 73.6 +/- 37.5 K/mu L, lactate dehydrogenase rose by 81.5 (44.3, 140.8) U/L, and leukocytes rose by 3.4 (2.2, 7.2) K/mu L on postoperative day 1. Conclusions: The venous smart canula (R) allows for optimal venous drainage at low negative drainage pressures, facilitating sufficient perfusion in MICS.
  • Simulation of a Right Anterior Thoracotomy Access for Aortic Valve Replacement Using a 3D Printed Model
    Item type: Journal Article
    Wamala, Isaac; Brüning, Jan; Dittmann, Johannes; et al. (2019)
    Innovations
  • The MANTA Vascular Closure Device for Percutaneous Femoral Vessel Cannulation in Minimally Invasive Surgical Mitral Valve Repair
    Item type: Journal Article
    Van Praet, Karel M.; Kofler, Markus; Jacobs, Stephan; et al. (2020)
    Innovations
    A 65-year-old Caucasian male was referred to our institution with severe mitral regurgitation due to posterior mitral leaflet prolapse. The patient underwent minimally invasive surgical mitral valve repair. Here we present the application of a new vascular closure device (MANTA) for percutaneous arterial access and closure.
  • SLL-PEEP Ventilation to Improve Exposure in Minimally Invasive Right Anterolateral Minithoracotomy Aortic Valve Replacement
    Item type: Journal Article
    Richter, Gregor; Van Praet, Karel M.; Hommel, Matthias; et al. (2021)
    Innovations
    Objective: An accepted landmark to assess feasibility of surgical aortic valve replacement (SAVR) via right anterolateral minithoracotomy (RALT) is the aortic-midpoint to right-sternal-edge distance. We aimed to evaluate single left lung positive-end-expiratory-pressure (SLL-PEEP) ventilation inducing an intraoperative rightward shift of the ascending aorta to improve exposure. Methods: Nineteen patients with aortic stenosis undergoing SAVR via RALT were prospectively analyzed. SLL-PEEP ventilation (20,395 cmH2O) via a double-lumen endotracheal tube was applied immediately before transthoracic aortic cross-clamping, thereby inducing rightward shift of the ascending aorta to enhance exposure. We analyzed preoperative computed tomography (CT) reconstructions and intraoperative video recordings. Primary endpoint was extent of rightward shift induced by SLL-PEEP ventilation; secondary endpoints were procedure times and safety events. Results: Mean age was 61 ± 14.8 years and 6 of 19 (31.6%) were female. Mean EuroSCORE II was 0.81% ± 0.04%, STS-PROM was 1.13% ± 0.74%, and mean aortic rightward shift induced by SLL-PEEP ventilation was 10.32 ± 4.14 mm (4 to 17 mm; P = 0.003). Median shift in the group considered suitable for the RALT approach by preoperative CT-scan evaluation was 14.2 mm (IQR 11) and in the less suitable group 11.5 mm (IQR 5). Mean procedure time was 167 ± 28.9 min, CPB time was 105.7 ± 18.4 min, and cross-clamp time was 64.5 ± 13 min. Fifteen patients (79%) received SAVR via RALT with implantation of a bioprosthesis, whereas a rapid-deployment-prosthesis was used in 4 patients (21%). Ten of 19 (53%) patients who were classified as less suitable preoperatively received SAVR via RALT after SLL-PEEP ventilation. No strokes were observed. Conclusions: The SLL-PEEP ventilation maneuver during SAVR via RALT significantly enhances aortic exposure. There were no safety events associated with this maneuver and we were able to demonstrate significant rightward aortic shift in every single patient.
  • Minimally Invasive Extirpation of Benign Atrial Cardiac Tumors: Clinical Follow-Up and Survival
    Item type: Journal Article
    Van Praet, Karel M.; Kofler, Markus; Wilkens, Kristin; et al. (2023)
    Innovations
    Objective: Evidence determining the optimal treatment for cardiac tumors is rare. We report our midterm clinical outcome and patient characteristics of our series undergoing atrial tumor removal through a right lateral minithoracotomy (RLMT). Methods: From 2015 to 2021, 51 patients underwent RLMT for atrial tumor extirpation. Patients receiving concomitant atrioventricular valvular, cryoablation, and/or patent foramen ovale closure surgery were included. Follow-up was performed using standardized questionnaires (mean: 1,041 ± 666 days). Follow-up involved any tumor recurrence, clinical symptoms, and any recurrent arterial embolization. Survival analysis was successfully achieved in all patients. Results: Successful surgical resection was achieved in all patients. Mean cardiopulmonary bypass and cross-clamping times were 75 ± 36 and 41 ± 22 min, respectively. The most common tumor location was the left atrium (n = 42, 82.4%). Mean ventilation time was 12.74 ± 17.23 h, intensive care unit stay ranged from 1 to 1.9 days (median: 1 day). Nineteen patients (37.3%) received concomitant surgery. Histopathological analysis showed 38 myxoma (74.5%), 9 papillary fibroelastoma (17.6%), and 4 thrombus (7.8%). Thirty-day mortality was observed in 1 case (2%). One patient (2%) suffered a stroke postoperatively. No patient had a relapse of cardiac tumor. Three patients (9.7%) showed arterial embolization during follow-up. Thirteen follow-up patients (25.5%) were in New York Heart Association class ≤II. Overall survival was 90.2% at 2 years. Conclusions: A minimally invasive approach for benign atrial tumor resection is effective, safe, and reproducible. Of the atrial tumors, 74.5% were myxoma and 82% were located in the left atrium. A low 30-day mortality rate with no manifestation of recurrent intracardiac tumor was observed.
Publications 1 - 6 of 6