DTA

Digital Theses Archive

 

Tesi etd-10252019-194304

Type of thesis
Master univ. II liv.
Author
SEVUK, UTKAN
URN
etd-10252019-194304
Title
Direct Vision Minimally Invasive Cardiac Surgery with Limited Resources
Course
Innovation in Cardiac Surgery: Advances in Minimally Invasive Therapeutics
Committee
relatore Prof. PASSINO, CLAUDIO
Relatore Dott. SOLINAS, MARCO
Keywords
  • central cannulation
  • direct vision
  • limited resources
  • minimally invasive
  • minithoracotomy
  • mitral valve
  • right infraaxillary thoracotomy
Exam session start date
31/10/2019;
Availability
completa
Abstract
Minimally invasive approaches have proven to be a safe and a feasible alternative to conventional sternotomy approach. To execute operations through small lateral working ports, specially designed surgical instruments, retractor set, periheral cannulas and imaging systems are required. This report describes a simplifed, reproducible minimally invasive approach to the mitral valve under direct vision using standard surgical instruments, cannulas and retractors.<br><br>Anesthesia is achieved using a conventional approach with single lumen endotracheal intubation. A 8- to 10-cm right vertical infra-axillary incision extending from second to fifth intercostal space along the antero or midaxillary line is made and the pleural cavity is entered through the third or fourth intercostal space. Standard chest retractors are used. Purse-string sutures are placed in a standard fashion with pledgeted sutures. Arterial and venous cannulations are performed through the thoracotomy incision. Ascending aorta is clamped through the incision using a standard cross-clamp Adequate myocardial protection is achieved with del Nido cardioplegia which is prepared at the operating room. No specially designed instruments or retractors are required, and the knots are tied by hand in a standard fashion. Defibrillation, when necessary, is administered through the regular internal defibrillator paddles<br>This strategy may help to establish a minimally invasive cardiac surgery program in hospitals with limited resources with good cosmetic results and reduced surgical trauma compared to median sternotomy approach.<br><br>
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