Port-access cardiac operations with cardioplegic arrest.
BACKGROUND
A less invasive approach to cardiac surgery has been propelled by recent advances in video-assisted surgery. Previous obstacles to minimally invasive cardiac operations with cardioplegic arrest included limitations in operative exposure, inadequate perfusion technology, and inability to provide myocardial protection.


METHODS
Port-access technology allows endovascular aortic occlusion, cardioplegia delivery, and left ventricular decompression. The endoaortic clamp is a triple-lumen catheter with an inflatable balloon at its distal end. Antegrade cardioplegia is delivered through a central lumen, which also acts as an aortic root vent, a second lumen is used as an aortic root pressure monitor, and a third lumen is used for balloon inflation to provide aortic occlusion.


RESULTS
Experimental and clinical studies have demonstrated the feasibility of port-access coronary artery bypass grafting and port-access mitral valve procedures. Endovascular cardiopulmonary bypass using the endoaortic clamp was effective in achieving cardiac arrest and myocardial protection to allow internal mammary artery to coronary artery anastomosis in a still and bloodless field. Intracardiac procedures, such as mitral valve replacement or repair, have been successfully performed clinically.


CONCLUSIONS
The port-access system effectively achieves cardiopulmonary bypass and cardioplegic arrest, thereby enabling the surgeon to perform cardiac procedures in a minimally invasive fashion. This system provides for endovascular aortic occlusion, cardioplegia delivery, and left ventricular decompression.
Fann
J I
JI
Department of Cardiothoracic Surgery, Stanford University School of Medicine, California 94305, USA.
Pompili
M F
MF
Stevens
J H
JH
Siegel
L C
LC
St Goar
F G
FG
Burdon
T A
TA
Reitz
B A
BA
D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass / Q000379:methods*; D004724:Endoscopy; D005260:Female; D006324:Heart Arrest, Induced; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D008943:Mitral Valve / Q000601:surgery; D014741:Video Recording