Minimally Invasive Cardiac Surgery: A Practical Guide

Cover
Half Title
Title Page
Copyright Page
Dedication
Table of Contents
Prologue
Acknowledgments
Our Editorial Team
Contributors
Chapter 1 Foreword/Introduction
	How to Get the Most Out of the Present Book
	Who Is the Primary and Secondary Readership of the Book
Chapter 2 History of Minimally Invasive Cardiac Surgery
	History or Introduction
	How It Has Been Done
	Tools/Instruments and Devices
	Perioperative Consideration
	Alternative Approaches
	Caveats and Controversies
	Research, Trends and Innovation
	Where and How to Learn
	References
Chapter 3 How to Set up a Minimally Invasive Program
	History or Introduction
	How to Do It/Step by Step
	Tools/Instruments and Devices
	Perioperative Consideration
	Alternative Approaches
	Caveats and Controversies
	Where and How to Learn
	References
Chapter 4 Instrumentation and Operating Theater Set up in Minimally  Invasive Cardiac Surgery
	Introduction
	How to Do It/Step by Step
	Minimally Invasive Valve Surgery
		Minimally Invasive Mitral Valve Surgery
		Minimally Invasive Aortic Valve Surgery
	Minimally Invasive CABG Surgery
		Positioning Draping of Patient
		Special Considerations
		Special Instruments and Consumables
	TAVI (Transfemoral and Transapical
	Femoral Cannulation Technique
		Cannula Selection
		Cannula Sizing
		The Insertion Technique
		Cannula Positioning
		Cannula Securing
		Open Cannulation for Endoballoon (Thruport
		Percutaneous Femoral Cannulation
	Tools/Instruments and Devices
		General Instrumentation
		Special Retractor for Minimally Invasive Mitral Valve Surgery
		Special Instruments for MICS CABG Surgery
		ThoraTrak Retractor
		Octopus Nuvo Stabilizer and Starfish NS Positioner
		Femoral Cannula
		Special Instruments
	Perioperative Consideration
	Alternatives
		Alternative Stabilizers
			Aesculap FLEXHeart
			Valve XS Atrium Retractor
		Alternative Cannulation Technique for CPB
			Axillary Artery Cannulation
			SVC Cannulation
			Conventional Cannulation
			Peripheral Cannulation Technique
			Robotic Surgery
			TAVI
	Caveats and Controversies
		Heart Valve Surgery
			MIS AVR: Approach – Upper J Sternotomy vs RATS
			TAVI vs SAVR
			MiMVR: Mini MVR vs Robotic-Assisted
			MICS CABG
	References
Chapter 5 Anesthesia for Minimally Invasive Cardiac Surgery
	History and Introduction
	How to Do It/Step by Step
		Monitoring
		Anesthetic Preparation
		Transesophageal Echocardiography (TOE
		Ventilation Strategy
		Principles Guiding Conduct of Anesthesia
	Tools/Instruments and Devices
	Perioperative Considerations
		Pre-Anesthetic Evaluation
		Positioning
		Postoperative Management
	Alternative Approaches
	Caveats and Controversies
		One-Lung Ventilation
		Postoperative Pulmonary Edema
		Surgical Techniques Impacting Anesthesia
			Deairing of the Heart
			Mitral Valve and Right Mini-Thoracotomy
			Long-Acting Cardioplegia
		MICS CABG
			Proximal Anastomosis
			Reinflating the Left Lung
	Research, Trends and Innovation
	Where and How to Learn
	References
Chapter 6 Surgical Approaches in Minimally Invasive Cardiac Surgery
	History or Introduction
	How to Do It/Step by Step
		Patient Selection, Preparation and Positioning
		Perioperative Considerations
	Tools/Instruments and Devices
	Alternative Approaches
		Alternative Caval Isolation for Right Heart
		Trans-areolar Endoscopic approach
	Caveats and Controversies
		Potential Complications and Troubleshooting
	References
Chapter 7.1 The Aortic Valve: Minimally Invasive Aortic Valve Replacement. The Right Anterior Minithoracotomy
	Introduction
	How to Do It/Step by Step
		Step 1: Patient Preparation and Exposure
		Step 2: CPB Installation – Cannulation, Cardioplegia and LV Venting
		Step 3: AVR – Aortotomy, Aortic Valve Exposure and Replacement
	Tools/Instruments and Devices
		Medtronic ThoraTrak (MICS Retractor System
	Perioperative Considerations
	Alternative Approaches
	Caveats and Controversies
	Research, Trends and Innovation
	Where and How to Learn
	References
Chapter 7.2 Minimally Invasive Aortic Valve Replacement: Upper “J” Sternotomy
	Introduction
	How to Do It/Step by Step
		Special Considerations
	Tools/Instruments and Devices
		Saw: Oscillating Saw
		Aortic Cannula: EOPATM
		Aortic Cross Clamp
		Automated Knot Fastener
	Perioperative Consideration
		Preoperative CT Scan of the Patient (CT Thorax, Abdomen and Pelvis
		Chest Wall Deformity
		Severe Calcified Ascending Aorta
		Reoperations/Redo Surgery
		Status Post-Pneumonectomy
		Obesity
		Post-Radiation Therapy
	Alternative Approaches
		Manubrium-Limited Sternotomy
		Suprasternal AVR
	Caveats and Controversies
	Research, Trends and Innovation
		Trans-Apical TAVI
		Valve-in-Valve
	Where and How to Learn
		Professional Education: LivaNova
		EACTS Academy
		National University Health System (NUHS), Singapore (ASTC
		Aortic Valve and Root Boot Camp
	References
Chapter 7.3 The Aortic Valve: Sutureless Valves in the Setting of MICS AVR
	History and Introduction
	How to Do It/Step by Step
		Patient Selection
		Perceval
		Intuity Elite Valve
	Tools/Instruments and Devices
		Perceval S (LivaNova Group, Milan, Italy
		Intuity (Edwards Lifesciences, Irvine, CA
	Perioperative Consideration
	Alternative Approaches
	Caveats and Controversies
	Research, Trends and Innovation
		Perceval
		Intuity
		Perceval versus Intuity
		Current Evidence and Future Prospects
	Where and How to Learn
		International Valvular Surgery Study Group (IVSSG
	References
Chapter 7.4 The Aortic Valve: Endoscopic Aortic Valve Surgery
	History and Introduction
	OT Setup and Instrumentation
	How to Do It/Step by Step
		Cardiopulmonary Bypass (CPB
		Aortic Cross Clamping, Cardioplegia and Ventricular Venting
		Surgical Technique
		Prosthetic Choice
		Summarized Experience
	Caveats and Controversies
	Where and How to Learn
		Conclusions
	References
Chapter 8.1 Transcatheter Aortic Valve Implantation (TAVI): Transapical  Transcatheter Aortic Valve Replacement
	History and Introduction
	How to Do It/Step by Step
		The Transapical Approach
		Operative Technique
	Tools/Instruments and Devices
	Perioperative Consideration
		Preoperative Assessment and Planning
	Alternative Approaches
	Caveats and Controversies
	Research, Trends and Innovation
	Where and How to Learn
	References
Chapter 8.2 Transfemoral Transcatheter Aortic Valve Implantation
	History and Introduction
	How to Do It/Step by Step
		Patient Selection
		Setup and Equipment
		Vascular Access
		Temporary Pacemaker Placement
		Aortic Root Angiogram
		Delivery Sheath Insertion
		Aortic Valve Crossing
		Balloon Aortic Valvuloplasty (BAV
		Valve Implantation
		Post-Valve Implantation Assessment
	Tools/Instruments and Devices
		Sapien 3 (Edwards Lifesciences, Irvine, CA, USA
		Evolut R (Medtronic, Fridley, MN, USA
		Lotus Edge (Boston Scientific, Marlborough, MA, USA
		Portico (Abbott, Chicago, IL, USA
	Perioperative Considerations
		Preoperative Assessment and Screening
		Echocardiogram
		Cardiac Catheterization
		Computed Tomography (CT) Angiography
		Associated Co-Morbidities
	Alternative Approaches
	Caveats and Controversies
		Paravalvular Regurgitation (PVR
		Cardiac atrioventricular conduction abnormalities
		Stroke
		Vascular Complications
		Specific Caveats
	Research, Trends and Innovation
		Current Status of TAVI
		Balloon Valvuloplasty Catheter
		Delivery Sheath Design
		Future of Transfemoral TAVI
	Where and How to Learn
		Medtronic TAVI course
		PCR Online TAVI Atlas
		ESC Courses
	References
Chapter 8.3 Transcatheter Aortic Valve Implantation (TAVI): Alternative Approaches for  Transcatheter Aortic Valve Implantation
	Introduction
		Alternative Approaches
	How to Do It/Step by Step
		Subclavian Transcatheter Aortic Valve Replacement (SC-TAVI
			Technique
			Pros and Cons
		Transaxillary Transcatheter Aortic Valve Replacement (TAX-TAVI
			Technique
			Pros and Cons
		Direct Aortic Transcatheter Aortic Valve Replacement (DA-TAVI
			Technique
			Pros and Cons
		Transcarotid Transcatheter Aortic Valve Replacement (TC-TAVI
			Technique
			Pros and Cons
		Transcaval Transcatheter Aortic Valve Replacement (TCA-TAVI
			Technique
			Pros and Cons
		Devices
		Peri-Procedural Considerations
		Where and How to Learn
			TAVI Fellowship
		References
Chapter 9.1 The Mitral Valve: Minimally Invasive Mitral Valve Surgery
	History and Introduction
	How to do it/Step by Step
		Position the Patient
		Installing Extracorporeal Circulation
		Myocardial Preservation
		Exposure
		Mitral Valve Repair Technique
	Tools/Instruments and Devices
		Medtronic Extracorporeal Cannula
		ThruPort IntraClude from Edwards Lifesciences
	Perioperative Considerations
	Caveats and Controversies
	Research, Trends and Innovation
	Where and How to Learn
		FOCUS Valve Workshops
		NUHCS Singapore Minimally Invasive Mitral Valve Programme
		Cleveland Clinic Minimally Invasive Mitral Repair
	References
Chapter 9.2 The Mitral Valve: Alternative Approaches to Minimally Invasive  Mitral Valve Surgery
	History or Introduction
	How to Do It/Step by Step
		Right Paramedian Approach
		Upper Sternotomy Approach
		Right Thoracotomy Approach
	Tools/Instruments and Devices
		MitraClipTM
		Tiara Valve
		AccuFit Valve
		TendyneTM Valve
		Cardiaq Valve
		Coronary Sinus-Based Percutaneous Mitral Annuloplasty
		Valtech Cardioband
		Mitralign
		GDS Accucinch
		Transapical Off-Pump NeoChord Implantation
		Valtech V-Chordal
		Mitra-Spacer
	Perioperative Consideration
	Alternative Approaches
		Transcatheter Mitral Valve Replacement
		Percutaneous Mitral Valve Repair
	Where and How to Learn
	References
Chapter 9.3 The Mitral Valve: Robotic Mitral Valve Surgery
	History and Introduction
	How to Do It/Step by Step
		Patient Selection
		Preparation
		Surgical Exposure and Access
		Cardiopulmonary Bypass and Myocardial Protection
		Operating on the Mitral Valve
		Concluding the Operation
	Tools/Instruments and Devices
		Da Vinci Xi System
		Alexis Wound Protector
		Endo Close™ Trocar Site Closure Device
		LivaNova Venous Return Cannulas
		Optisite Arterial Cannulas
		MiaR™ Cardioplegia Cannula
		Chitwood Debakey Aortic Cross-Clamp
		StrykeFlow II Suction Irrigation Pump
	Perioperative Consideration
		Preoperative Assessment
		Previous Cardiac Surgery
		Clinical Outcomes
	Alternative Approaches
		LEAR Technique
		Cardioplegia
		Cross-Clamp
		Reoperative Surgery
	Caveats and Controversies
	Research, Trends and Innovation
	Where and How to Learn
		Annals of Cardiothoracic Surgery (ACS) Video Atlas
		STS workshop on Robotic Cardiac Surgery
	References
Chapter 9.4 The Mitral Valve: Percutaneous Mitral Valve Repair: MitraClip®
	History and Introduction
		Percutaneous Mitral Valve Repair Using the MitraClip® System
	How to Do It/Step by Step
		Steps
		Surgical Approach
			Transseptal Puncture
			Anatomy of the septum
	Tools/Instruments and Devices
	Perioperative Consideration
		Indications for MICS Procedure
		Patient Selection
		Contraindications
	Alternative Approaches
		A look to current and soon-to-come transcatheter mitral valve repair options
	Caveats and Controversies
		From the Cardiologist’s point of view
			Transcatheter Mitral Valve Repair Today and Tomorrow
			Experiences so far
		Real-World Experience
			Butterfly in the Heart
			Beyond EVEREST
	Research, Trends and Innovation
		ACCESS-EU PHASE I
		ACCESS-EU PHASE II
	Where and How to Learn
Chapter 10 Minimally Invasive Tricuspid Valve Surgery
	History and Introduction
		Tricuspid Regurgitation
		TR at the Time of Left-Sided Heart Surgery
		Tricuspid Stenosis
	How to Do It/Step by Step
		Exposure of the Heart and Right Atrium
		Cannulation and Cardiopulmonary Bypass
		Aortic Clamping and Cardioplegia Delivery
		Main Operation (TV Repair or Replacement
		Completion of the Procedure
		Redo Right Mini Thoracotomy TV Surgery (after Previous Pericardiotomy
	Tools/Instruments and Devices
	Perioperative Consideration
	Alternative Approaches
	Caveats and Controversies
	Research, Trends and Innovation
	Where and How to Learn
	References
Chapter 11 Minimally Invasive Combined Heart Valve Surgery
	Introduction
	How to Do It/Step by Step
		Upper J sternotomy Approach for Double Valve Repair/Replacement
 (AVR+MVR
		Upper T Sternotomy Approach
		Right Mini-Thoracotomy Approach
			Caval Isolation
			Caval Occlusion
		Concomitant Procedures
	Tools/Instruments and Devices
		External Defibrillator Pads
		Soft Tissue Retractor
		Atrial Lift System and Visor
	Alternatives
		Conventional Full Sternotomy Approach
		Caval Isolation
	Caveats and Controversies
		Combined Procedures in Minimally Invasive versus Conventional Approaches
	Research, Trends and Innovation
		Soft Robotics in Minimally Invasive Surgery
	Where and How to Learn
		Minimally Invasive Techniques in Adult Cardiac Surgery (MITACS
		International Society for Minimally Invasive Cardiothoracic Surgery (ISMICS)
 Courses
	References
Chapter 12.1 The Coronaries: Minimally Invasive Coronary Artery Bypass Grafting Surgery
	History or Introduction
	How to Do It/Step by Step
		Patient Positioning
		Chest Marking and Incision
		Harvesting the Left Internal Thoracic Artery (LITA
		Proximal Anastomosis
		Distal Anastomosis
		Chest Closure
		Post-Operative Care
	Tools/Instruments and Devices
	Perioperative Consideration
		Anesthesia
	Alternative Approaches
	Caveats and Controversies
	Research, Trends and Innovation
	Where and How to Learn
	References
Chapter 12.2 The Coronaries: Robot Facilitated Coronary Artery Bypass Grafting
	History and Introduction
	How to Do It/Step by Step
		Patient Selection
		Preparation
		Operative Guide
			Step 1: Patient Placement and Operative Start-Up
			Step 2: Port Insertion and Robot Docking
			Step 3: Internal Mammary Artery Takedown
			Step 4: Utility Port Placement
			Step 5: Precordial Fat Pad Resection and Pericardial Exposure
			Step 6: Vascular Cannulation and Application of Endoclamp
 (Endoballoon Occlusion
			Step 7: Cardiopulmonary Bypass
			Step 8: Identification and Exposure of the Target Vessels
			Step 9: Robot-Facilitated Endoscopic Coronary Anastomosis
			Step 10: Final Actions
	Tools/Instruments and Devices
	Perioperative Consideration
		Preoperative Assessment and Work-Up
		Anesthetic Considerations
		Postoperative Care
		Time Demand
	Alternative Approaches
		Cannulation
		Cardioplegia
		TECAB Approaches
		Coronary Grafting Options
		TECAB as Hybrid Coronary Procedure
	Caveats and Controversies
		Contraindications to TECAB
		Endoballoon
		Extracorporeal Circulation
		Coronary Anastomosis
		Other Caveats
	Research, Trends and Innovation
		Reduced Surgical Trauma Advantages
		Intermediate- and Long-Term Outcomes
		Predictors of Success and Safety, Further Patient Aspects
		Summary and Future Aspects
	Where and How to Learn
	References
Chapter 12.3 Anaortic, Off-Pump, Total-Arterial Coronary Artery Bypass Grafting Surgery: The Coronaries
	History and Introduction
		Introduction
		History of OPCAB and Technical Innovation
	Research, Trends and Innovation
		Stroke and Other Peri-Operative Complications
		High-risk Patients
	Caveats and Controversies
		Complete Revascularization and Long-Term Outcomes
	How to Do It/Step by Step
		Anaortic OPCAB Surgical Technique
	Tools/Instruments and Devices
	Alternative Approaches
	Where and How to Learn
		EACTS OPCAB Fellowship
		EBM Beat + YOUCAN Simulator
	Summary
	References
Chapter 12.4 The Coronaries: Hybrid Coronary Artery Bypass Grafting Surgery
	History and Introduction
	How to Do It/Step by Step
	Tools/Instruments and Devices
	Perioperative Consideration
	Alternative Approaches
	Caveats and Controversies
	Research, Trends and Innovation
		ISMICS 2014 Annual Meeting presentation
	References
Chapter 13 Minimally Invasive Atrial Ablation Surgery
	History and Introduction
	How to Do It/Step by Step
		Minimally Invasive Cox Maze Procedure
		Pulmonary Vein Isolation
		Pruitt Box Lesion
		Wolf Mini Maze
		PVI via Right Minithoracotomy
	Pulmonary Vein Isolation and Autonomic Denervation
		Dallas Lesion Set
		Five Box Ablation
	Tools/Instruments and Devices
	Perioperative Considerations
		Paroxysmal versus Persistent AF
		Minimally Invasive Surgical versus Catheter Ablation
		Comorbidities
	Alternative Approaches
		Hybrid Ablation
			Thoracoscopic Approach
			Subxiphoid Pericardioscopic Approach
			Transdiaphragmatic Combined Subxiphoid and Laparoscopic Approach
		Concomitant Minimally Invasive AF Ablation and Mitral Valve Surgery
		Left Atrial Appendage Exclusion
	Caveats and Controversies
		Epicardial Ablation for AF
		Hybrid Ablation for AF
	Research, Trends and Innovation
		Minimally Invasive Cox Maze
		Minimally Invasive Pulmonary Vein Isolation
			Pruitt Box Lesion
			Wolf Mini Maze
			Pulmonary Vein Isolation via Right Minithoracotomy
		Pulmonary Vein Isolation and Autonomic Denervation
			Dallas Lesion Set
			Five-Box Ablation
		Hybrid Surgery for AF
			Thoracoscopic Approach
			Subxiphoid Pericardioscopic Approach
			Transdiaphragmatic Combined Subxiphoid and Laparoscopic Approach
		Concomitant Atrial Ablation with Minimally Invasive Mitral Surgery
	Conclusion
	Where and How to Learn
		International Society of Minimally Invasive Cardiac Surgery (ISMICS) Workshop
		AtriCure Education and Training
		The Journal of Innovations in Cardiac Rhythm Management
	References
Chapter 14.1 Aortic Surgery: Minimally Invasive Ascending Aortic Surgery
	History or Introduction
		Minimally Invasive Aortic Surgery for Cardiovascular Surgeons
		History
	How to Do It/Step by Step
		Surgical Approach
			Aortic Root, Ascending Aorta with or without Proximal Arch, Total Arch
		Endovascular Repair of the Ascending Aorta
		Endovascular Repair of Aortic Arch
		Descending Thoracic Aorta
		Thoracoabdominal Aorta
	Tools/Instruments and Devices
		FDA-Approved Stent Grafts
	Perioperative Consideration
		Indications for Minimally Invasive Aortic Surgery
			Ascending Aorta and Aortic Arch
		Descending Thoracic Aorta
	Alternative Approaches
	Caveats and Controversies
	Research, Trends and Innovation
		Current Results
		Ascending Aorta: Endovascular Repair
		Arch and Descending Thoracic Aorta
			Hybrid Results
		Endovascular Repair
		Descending Thoracic Aorta
	Where and How to Learn
	References
Chapter 14.2 Aortic Surgery: Endovascular and Hybrid Approaches for Distal Arch  and Descending Thoracic Aorta
	History or Introduction
		Distal Arch Aneurysms
		Descending Aortic Aneurysms
		Traumatic Aortic Injury
		Penetrating Aortic Ulcers
		Intramural Hematoma
		Coarctation of Aorta
		Type B Aortic Dissections
		Other Pathologies
	How to Do It/Step by Step
		Arch Debranching
		Evolution of the “Visceral Hybrid” Repair for Thoracoabdominal Aortic Pathology
		General Principles
		Treatment Techniques
		Zone 1 Pathologies
		Zone 2 Pathologies
		Zone 3 Pathologies
		St Mary’s Visceral Hybrid Repair Technique
	Alternative Approaches
		Standard Approach (Transfemoral
		Conduits
		Iliac/Infra-Renal Abdominal Aortic Approach
		Thoracic Aortic Approach
	Tools/Instruments and Devices
		Tools/Instruments
			Devices
			Standard TEVAR Devices
			Custom-Made TEVAR Devices
			Hybrid Open TEVAR Devices
	Perioperative Considerations
		Device and Stock Considerations
		Radiation Protection
		Lumbar Spinal Drainage
	Caveats and Controversies
		Subclavian Artery Coverage
		Chimney Techniques
	References
Chapter 15 Minimally Invasive Heart Failure Surgery
	Introduction
		Operations for Heart Failure
	How to Do It/Step by Step
		Minimally Invasive LVAD Implantation
		Technique
			Surgical Access
			Circulatory Support
			Operation
		Special Concerns
	Tools/Instruments and Devices
		Acorn CoreCap
		HeartWare VAD (HVAD
		HeartMate III
	Alternatives
		Conventional Full Sternotomy Approach
	Caveats and Controversies
		Abandoned Surgical Options
		Managing Arrhythmias in LVAD Patients
		Park’s Plication Stitch for AI at the Time of LVAD
		Bilateral Mini-Thoracotomy vs Separate Incisions
		Sternal-Sparing Approach
		Off-Pump vs On-Pump LVAD Implantation
		Minimally Invasive vs Conventional LVAD Implantation
	Research, Trends and Innovation
		Heart Failure Therapy Update
	Where and How to Learn
		ISHLT
		Postgraduate Courses on Heart Failure in London
	References
Chapter 16 EPILOGUE
Annex
Index