Minimally Invasive Cardiac Surgery --Videoscope-assisted cardiac surgery (VACS) 陳陳陳 陳陳陳陳 陳陳 陳陳陳
Minimally Invasive Cardiac Surgery--Videoscope-assisted cardiac
surgery (VACS)
陳勁辰亞東醫院
台灣 新北市
Minimally Invasive CS (MICS)
• Minimal access CS (MACS)• Videoscope-assisted CS (VACS)– Cf: Direct vision in MICS/MACS– Thoracoscopic: 2D images, tactile, self– da Vinci robotic: 3D images, non-tactile, $,
assistant
Issues
• Prep: positioning, e-shock pads• Cannulation: peripheral• Myocardial protection: route• Procedure as good as open*• Hemostasis• Pain
Outlines
• Benefits & risk• Preop• Op• ====• Robotic-assisted CABG• Mitral valve• Aortic valve• Robotic mitral
Preop Variables for Choosing MICS (MPS, MTC) in Low-Risk Cases (Elective, LVEF>=30%, and EuroScore-II<=10%)
N=722 OR OR 95% CI p-value
EuroScore-II0.77 (per
1%)0.69 ~ 0.85 <0.01
Non-MS MR 1.841.06 ~ 3.20 0.031
HOCM 0.080.02 ~ 0.30 <0.001
MPS: Mini-parasternotomyMTC: Mini-thoracotomy
MICS(minimally-invasive cardiac surgery): MPS or MTCInitial variable set: MR, MS, AS, AR, TR, Af, IE, HOCM; sex, age, DM, HTN, uremia, EuroScore-II,Multiple logistic regression with stepwise selection
Pre-Op
• Endoscopic vein harvesting: Vein echo mapping
• EuroScore-II• Lung function: one -lung• Chest non-contrast CT: aorta, anatomy• Ankle-Brachial index: femoral artery• Carotid doppler: stroke• Workup for medical condition
Valves
• Parasternal– Aortic valve
• Thoracotomy– Mitral valves– Others
• Heart echo: confirm, new lesion?
Schematic illustrations (1)
Schematic illustrations (2)
Less Invasive Mitral Valve Surgery
Pre-operative ImagePleural adhesion?
AP diameter Cardiac axis
Scope-Assisted MICS
Positioning
Vacuum-Assisted Venous Drainage
Figure 1
Figure 2
A B
C D
Figure 3
A B
C D
D
BA
C
Figure 4
da Vinci Robotic MVR
Delacroix-Chevalier Instruments
THANK YOU!
Op Tech in Thorac Cardiovas Surg 2007: 235-249
Op Tech in Thorac & Cardiovas Surg 2007: 235-249
Op Tech in Thorac Cardiovas Surg 2007: 235-249
Op Tech in Thorac Cardiovas Surg 2007: 235-249
Op Tech in Thorac Cardiovas Surg 2007: 235-249
Op Tech in Thorac Cardiovas Surg 2007: 235-249
Op Tech in Thorac Cardiovas Surg 2007: 235-249
Op Tech in Thorac Cardiovas Surg 2007: 235-249
Op Tech in Thorac Cardiovas Surg 2007: 235-249