Direct minimally invasive approach for aortic root replacement.

The author describes a minimally invasive approach for aortic insufficiency associated with severe calcification of the ascending aorta. The Bentall operation was easily performed through an 8 cm skin incision affording excellent exposure of the operating field, and with the use of CPB with vacuum-assisted venous drainage and clamping the aorta with a Casgrove flex clamp.

Minilaparotomy for abdominal aortic aneurysm repair: preliminary results.

A median laparotomy is the standard approach for endoaneurysmorrhaphy of abdominal aortic aneurysms. The so-called minilaparotomy, which has come into use in recent years to reduce surgical trauma, provides good exposure of the operating field, similar to that afforded by the conventional procedure. From the beginning of June 1999 through the end of October 2000, we used a minilaparotomy for abdominal aortic endoaneurysmorrhaphy in 26 patients. Endoaneurysmorrhaphy was performed without difficulty through an 8- to 10-cm paraumbilical transperitoneal incision. Aneurysms greater than 10 cm in diameter, prior abdominal surgery, and obesity were considered contraindications to the operation. Two of the 26 patients required conversion to full laparotomy because of intraoperative bleeding. There was 1 wound infection and no fatality. The technique proved to be safe, effective, and aesthetically acceptable to the patient. The laparoscopic approach to vascular surgery is still in its experimental phase. Although the minilaparotomy appears to be of great potential benefit, further study is needed to compare its postoperative results with those of standard median laparotomy.

Minimally invasive parasternal approach to tricuspid valve avoids repeat sternotomy.

We report the case of a 68-year-old patient with severe tricuspid regurgitation who had previously undergone aortic valve replacement and right coronary artery bypass. We performed tricuspid valvuloplasty via the right parasternal route in order to reduce surgical trauma by avoiding resternotomy, trauma to the venous graft, and bleeding due to dissection of old adhesions. The patient's postoperative course was uneventful, and he was discharged home on the 7th postoperative day.

Local pulmonary malformation caused by bilateral coronary artery and bronchial artery fistulae to the left pulmonary artery in a patient with coronary artery disease.

At 10 years of age and again at 25, our patient had been treated for pulmonary tuberculosis due to the presence of a localized pulmonary shadow. Coronary angiography at age 59 revealed 3 fistulous communications: from the right and circumflex coronary arteries and from the left bronchial artery. All 3 emptied into the same recipient artery, the distal part of a left pulmonary artery branch, which produced substantial left-to-right shunt. On computed tomography, cystic formations could be seen in the pulmonic area. The pulmonary tuberculosis for which this patient had been treated in his youth was in the same part of the lung where the shunt was discovered. Our conclusion is that the initial diagnosis was in error.

Aortic and mitral valve replacement through a minimally invasive approach.

Less invasive approaches to cardiovascular surgery are used increasingly to reduce surgical trauma and shorten hospital stay. The rarely used upper partial sternotomy and parasternal incision can confer the advantages of a smaller surgical wound: reduced blood loss, decreased risk of infection, shorter intubation, earlier discharge, decreased postoperative pain, and a smaller, cosmetically more acceptable postoperative scar. Moreover, reoperation is less hazardous, because the pericardium was not completely dissected. From the beginning of December 1996 to the end of January 1998, a minimally invasive approach was used for aortic valve replacement in 10 patients, and for mitral valve replacement in 2 patients. Patients with coronary artery disease, aneurysm of the ascending aorta, and poor ejection fraction were excluded from the group, but diabetes mellitus, obesity, and impaired pulmonary function were not considered contraindications to the operation. No patients required conversion to full sternotomy or reoperation. There were no wound infections, neurological deficits, or fatalities. The technique has proved safe, effective, and aesthetically acceptable to the patient.