Endoscopic Cardiac Surgery: Tips, Tricks and Traps 9783031211034, 9783031211041, 3031211030

Table of contents :
Foreword
Preface
Contents
1 Operative Planning for Safe Endoscopic Mitral Valve Surgery
Abstract
1 Introduction
2 Teamwork Approach
3 Procedural Planning
3.1 Electrocardiography
3.2 Chest X-ray
3.3 Echocardiography
3.4 Coronary Angiography
3.5 Computed Tomography
4 Future Perspectives
References
2 Anaesthesia for Endoscopic Cardiac Surgery
Abstract
1 Introduction
2 Preoperative Assessment
2.1 Cardiovascular
2.2 Respiratory
2.3 Gastrointestinal
2.4 Assessment of Frailty
3 Patient Set Up, Positioning and Monitoring
4 Standard Set Up for These Procedures
5 Additional Set Up in Specific Cases
5.1 Use of Endo Balloon
5.2 Right Heart Procedures
5.3 Redo Procedures
6 Induction of Anaesthesia
7 Intubation—Single Lumen Tube (SLT) Plus Bronchial Blocker (BB) Versus Double Lumen Tube (DLT)
8 Cerebral Oximetry
9 Transoesophageal Echocardiography
10 Jugular Vein Cannulation
11 Jugular Vein Cannulation in Re-do Right Heart Surgery
12 Patient Positioning
13 Start of Surgery
14 One Lung Ventilation with Use of Bronchial Blocker
15 Prebypass Management
16 Cardioplegia Delivery
17 Management During CPB
18 Separation from Cardiopulmonary Bypass
19 Cerebral Oximetry
20 Removal of Jugular Venous Drainage Cannula
21 Postoperative Care
21.1 Analgesia
22 Pulmonary Oedema
22.1 Bleeding and Re-exploration
22.2 Pacing After Surgery
22.3 Haemodynamic Instability
23 Enhanced Recovery
References
Further Readings
3 Transoesophageal Echocardiography for Safe Endoscopic Cardiac Surgery
Abstract
1 Standard Assessment of Surgical Pathology and Other Structures
References
4 Endoscopic Conduit Harvesting: Best Practice Training Guidelines
Abstract
1 Introduction
2 Methods
3 Results
3.1 Patient Selection
3.2 Contraindications for EVH and Rationale
4 Ideal Patients for EVH Training
4.1 Surgical Training for EVH
4.2 Structured Training
5 E-Learning Theoretical Module
6 Vein Doppler Ultrasound Mapping
7 Importance of Heparinisation Prior to EVH Technique
7.1 Diathermy Settings
7.2 CO2 Settings and Insufflation
8 Harvesting the Vein with Surrounding Tissues During EVH
9 Volume Thresholds and Learning Curve
9.1 Trainee Volume Threshold
9.2 Competency Volume Threshold for Experienced Practitioners
9.3 Continuous Professional Development
10 Use of Pressure-Controlled Syringe
11 Use of Closed Vacuum Suction Drain on the Leg
12 Avoiding Potential Complications
13 Audit
14 Discussion
15 Conclusion
16 Competing Interests
Acknowledgements
References
5 Endoscopic Cardiac Surgery—Tips, Tricks and Traps; Endoscopic Vessel Harvesting for Coronary Artery Revascularization Surgery with a Non Sealed Reusable System
Abstract
1 Introduction and Background
2 Patient Selection
3 Surgical Instruments
4 Endoscopic Radial Artery Harvesting Technique
4.1 Preliminary Details
4.2 Surgical Exposure
4.3 Endoscopic Harvesting
4.4 Radial Artery Endoscopic Retrieval
5 Endoscopic Saphenous Vein Harvesting Technique
5.1 Preliminary Details
5.2 Surgical Exposure
5.3 Endoscopic Harvesting
5.4 Saphenous Vein Endoscopic Retrieval
6 Comments
References
6 Endoscopic Closed Tunnel Conduit Harvesting: Tips, Tricks and Traps
Abstract
1 Introduction
2 Greater Saphenous Vein
4 Endoscopic Radial Artery Harvesting
5 Conclusion
References
7 Endoscopic Vein Harvest Using an Open System (Terumo®)
Abstract
1 Introduction
2 Pre-operative Considerations
2.2 Orientation to the Terumo System (See Video 1)
2.3 Theatre Set-Up
2.4 Pre-operative Patient Assessment
2.5 Patients Past Medical History
2.6 Clinical Examination
2.7 Ultrasound
2.8 Other Points to Note
3 Intra Operative Procedure
3.1 Patient Positioning
4 Traps, Tips and Tricks
4.1 Bleeding
4.2 Large or Bifurcating Tributaries
4.3 Fat in Tunnel
4.4 Superficial Saphenous Vein
4.5 Orientation
4.6 CO2 Blockage
4.7 Thermal Spread
4.8 Twisted/Tangled Vein
5 Post-operative Complications
5.1 CO2 Embolus
5.2 Saphenous Nerve Injury
References
Further Reading
8 Endoscopic Mitral Valve Surgery Using the External Clamp
Abstract
1 Arguments for the External Clamp
2 Preoperative Decision Making Process
3 Preoperative Radiological Examinations
4 Anesthesia and Positioning of the Patient
5 Cannulation and Cardiopulmonary Bypass (Video 1)
6 Surgical Access
7 The Set Up (Figs. 3, 4, 5 and 6)
8 Placement of the External Clamp (Video 4)
9 Atriotomy
10 Mitral Valve Repair
11 Mitral Valve Replacement
12 Concomitant Tricuspid Repair
13 End of the Operation and Deairing
References
9 The Endo-Aortic Balloon Technique in Totally Endoscopic Atrioventricular Valve Surgery
Abstract
1 Operative Theatre Design for Totally Endoscopic Cardiac Surgery and Patient Selection
2 Preoperative Planning of the Procedure
3 Anesthesia
4 Peripheral Vascular Cannulation and IntraClude™ Positioning
5 Aortic Cross-Clamping: Balloon Inflation, Antegrade Cardioplegia Delivery and Venting
6 Discussion
References
10 Endoscopic Tricuspid Valve Surgery: Planning and Deployment
Abstract
1 General Consideration
2 Preoperative Planning
2.1 Chest X-Ray and CT Scan
3 The “Virtual Operation” Using CT Scan as a Guide
4 Anesthesia and Jugular Vein Cannulation
5 Patient Positioning
6 Surgical Access
7 Cardiopulmonary Bypass Setup
8 Exposure of the Surgical Field
9 Operative Phase
10 Special Considerations—Redo and Beating Heart Operative Tricuspid Valve Surgery
11 Adjunctive Techniques and Adult Congenital Heart Disease
12 End of Procedure
References
11 Minimally Invasive Endoscopic Maze Procedure for Atrial Fibrillation Through Right Mini-thoracotomy
Abstract
1 Technique
1.1 General Considerations
1.2 Cannulation
1.3 Access to the Chest
1.4 Myocardial Preservation
1.5 Access to the Left Atrium and Left-Sided Lesions
1.6 Right-Sided Lesions
2 Results
3 Conclusion
References
12 Totally 3D-Endoscopic Aortic Valve Replacement
Abstract
1 Introduction
2 Operative Technique
2.1 The Set Up: Patient Positioning, 3D Endoscope, and Monitor
2.2 The Three-Port Technique (Video1)
3 Cardiopulmonary Bypass to Cross-Clamp
4 Summary
References
13 Totally Endoscopic Aortic Valve Replacement
Abstract
1 Introduction
2 General Overview
3 Steps of the Operative Technique of the TEAVR
5 Brief Presentation of Our Experience in TEAVR
6 Discussion
7 Conclusions
Disclosures
References
14 Endoscopic Repair of Septal Defects
Abstract
1 Introduction
2 Atrial Septal Defects
References
Further Recommended Viewing
15 Multi-vessel Endoscopic Coronary Artery Bypass Grafting
Abstract
1 Anesthesiological Preparation
2 Position of the Endoscopic ports
3 Endoscopic Mammary Artery Harvesting
4 Groin Vessel Cannulation
5 Mini-Thoracotomy
6 Cardioplegia Catheter
7 Mobilising the Heart
8 Coronary Artery Anastomosis Technique
9 Weaning from CPB
10 Graft Construction
References
16 Endoscopic Surgery for Cardiac Tumours
Abstract
1 Epidemiology and Pathology
2 Role of Minimally Invasive Surgery
References
17 Cannulation Techniques for Cardiopulmonary Bypass in Endoscopic Cardiac Surgery
Abstract
1 Introduction
2 Arterial Cannulation
2.1 Femoral Cannulation
2.2 Axillary Cannulation
2.3 Central Aortic Cannulation
2.4 Endo-Clamp Occlusion Balloon
3 Venous Cannulation
3.1 Femoral Cannulation
3.2 Internal Juglar or Subclavian Venous Cannulation
3.3 Central Venous Cannulation
4 Complications of Cannulation
4.1 General Considerations
4.2 Arterial Cannulation Site Complications
4.3 Venous Cannulation Site Complications
5 Comment
References
18 Endoscopic Mitral Surgery in Cardiogenic Shock
Abstract
1 Introduction
2 Operative Considerations
3 Postoperative Management
4 Severe Mitral Valve Stenosis
5 Ruptured Papillary Muscle
8 Conclusion
References
19 The Role of Simulators in Safe Adoption of Endoscopic Mitral Valve Surgery
Abstract
1 Introduction
2 Simulation for Mitral Valve Surgery
3 Patient Specific 3D Mitral Valve Modelling for Training Purpose
4 Clinical Applications
5 Future Perspectives
References
20 Trial of Current 3D Imaging Systems
Abstract
1 Introduction
2 3D Endoscope Practice Test
3 Conclusion
References
21 MiECC as Support for Endoscopic Cardiac Surgery
Abstract
1 Introduction
2 MiECC as Support for Minimal Invasive Cardiac Surgery
3 Team Approach
4 Cannulation
4.1 Venous Cannulation
4.2 VAVD-KVAD
4.3 Arterial Cannulation
4.4 Safety Concerns
4.5 Venting
4.6 Cardioplegia
5 MiECC-Experience
6 Conclusion
Appendixes
References
22 Innovation in Cardiac Surgery: It Takes a Village—Our Team’s Story: A Quest for Routine Sternal-Sparing CABG
Abstract
1 Introduction
3 Surgical Innovation Team Building—From R&D to Patient
4 Cardiac Surgery Innovation: Project μCAB
5 In Conclusion
References
Additional Resources
23 Psychological Context, Individual Differences and Adjustment in Relation to Cardiac Surgery Scars
Abstract
References
24 Leadership, Interpersonal Dynamics and the Adoption of Minimally Invasive Endoscopic Mitral Valve Surgery
Abstract
1 Introduction
1.1 Background History of MIS in the United Kingdom
2 The National Context
2.1 Psychology and Lesson
3 The Organizational Context—The Hospital
3.1 Psychology and Lesson
4 Collegial Support
4.1 Psychology and Lesson
5 The Theatre Team
5.1 Psychology and Lesson
6 The Surgeon
7 Conclusions
References
Index