femflex

Minimally Invasive
Cardiac Surgery
Overview
Traditional approach to heart valve surgery has been through
a median sternotomy. The breast bone is sawed in half in
order to approach the heart. Figure 1.
Raymond Lee, MD
Mark Mostovych, MD
Jacksonville, Florida
USA
Minimally invasive techniques are used for aortic and mitral
valve surgery. Our minimally invasive approach involves
approaching the heart between the ribs and leaves the sternum
intact. Figure 2.
For minimally invasive surgery, the incision is about 3 to 4
inches instead of the incision required for traditional surgery
that is 6 to 8 inches long.
MICS
Potential Benefits
of Minimally
Invasive Surgery
A smaller incision/scar
Less bleeding/transfusion
Decreased need for rehab
Figure 1.
Figure 2.
Improved
pulmonary function
Decreased length of stay 1,2
Decreased recovery time:
the average recovery
time after minimally
invasive surgery is 2 to 4
weeks, while the average
recovery time after
traditional heart surgery
is 6 to 8 weeks
Increased mitral valve
repair due to optimal
visualization and exposure
The views and teaching techniques expressed are those of medical
professionals and not necessarily the views of Sorin Group USA, Inc.
Technique Overview
Less pain/pain meds
Case: 65 yr. old male
with severe AS (0.7cm2,
65mm Hg gradient).
Technical Aspects
• Patient supine with arms tucked at side
• Double lumen endotracheal tube, radial arterial line to avoid
groin lines, defib pads since it is difficult to defibrillate
via incision
• ECHO guidance for retrograde cardioplegia catheter,
surgeon places retrograde catheter
• Avoid any lines in right subclavian or femoral areas
Aortic Valve Replacement
• Incision in second interspace (between second and third ribs)
• Divide RIMA, shingle third rib close to sternal edge and laterally
• Edwards soft tissue retractor and Estech™ retractor
• Resect thymic fat pad, avoid phrenic nerve
• Pericardial retraction sutures using percutenous needle
for lateral pericardial sutures
• Mitroflow® Aortic Pericardial Heart Valve
• Cannulation
-- EasyFlow™ Aortic Cannula (#103-300)
-- Edwards Fem-Flex II™ femoral venous cannulae with
connector, VFEM022 (Size: 22 Fr.) or VFEM024 (Size: 24 Fr.)
based on patient size
-- CardioVasive™ Chitwood Transthoracic Aortic Cross Clamp,
antegrade and retrograde cardioplegia
Case: 42 yr. old female
with known mitral valve
prolapse who developed
acute SOB and decreased
exercise tolerance.
Mitral Valve Surgery
• Incision in third interspace shingle third or fourth rib based
on body habitus
• Alternatively, may use inframammary incision
• Edwards soft tissue retractor and Estech retractor
• Resect thymic fat pad, avoid phrenic nerve
• Pericardial retraction sutures using percutenous needle
for lateral pericardial sutures
• MEMO 3D™ Semi-rigid Annuloplasty Ring
• Cannulation
-- Percutaneous femoral vein 2 stage cannula to drain SVC
and IVC effectively with the Bio-Medicus® Multi-Stage
Cannulae, 96880-021 (Size: 21 Fr.) or 96880-025 (Size: 25 Fr.)
MICS
-- EasyFlow Aortic Cannula (#103-300)
based on patient size
antegrade and retrograde cardioplegia
How Do I Begin?
Sorin Heart Valves offers peer-to-peer education for those
interested in learning how to do a minimally invasive AVR/
MVR procedure. Please contact your Sorin Group sales
representative for more information.
Technique Overview
-- CardioVasive Chitwood Transthoracic Aortic Cross Clamp,
References
1
BWH Ann Surg 2004;240(3):529
2
NYU Ann Thorac Surg 2002;74(3)660
Edwards and Fem-Flex II are trademarks of Edwards Lifesciences Corporation.
Estech and EasyFlow are trademarks of Endoscopic Technologies, Inc.
Bio-Medicus is a registered trademark of Medtronic, Inc.
CardioVasive is a trademark of Scanlan International.
Mitroflow is a registered trademark and MEMO 3D is a trademark
of Sorin Group USA, Inc.
Indications:
The Mitroflow® Aortic Pericardial Heart Valve is
intended for the replacement of diseased, damaged,
or malfunctioning native or prosthetic aortic valves.
The MEMO 3D™ Semi-rigid Annuloplasty Ring is
intended for correction of mitral insufficiencies or
steno-insufficiencies.
Heart Valves
Sorin Group USA, Inc.
14401 W. 65th Way, Arvada, CO 80004
United States of America
Tel. 800.289.5759 Fax 877.657.3605
© 2010 Sorin Group
www.sorin.com
Caution: Federal law (USA) restricts this device
to sale by or on the order of a physician.
PMC 0165 2010