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