Port-Access cardiac surgery using endovascular cardiopulmonary bypass: theory, practice, and results.
BACKGROUND
Reduction of surgical trauma is the aim of minimally invasive cardiac surgery. This can be achieved by reducing the size of the incision or by eliminating or changing the cardiopulmonary bypass system. However, certain cardiac surgical procedures, such as valvular surgery and complex multivessel coronary artery surgery, are not feasible without the use of cardiopulmonary bypass. Therefore endovascular cardiopulmonary bypass may allow reduction of surgical trauma for these patients.


METHODS
Since its first application in April 1995, more than 1100 procedures have been performed worldwide using the EndoCPB endovascular cardiopulmonary bypass system. The authors' experience consists of 60 Port-Access coronary artery bypass grafting procedures, 34 Port-Access mitral valve procedures (18 replacements, 16 repairs), 5 atrial septal defect closures, and 3 atrial myxoma removals.


RESULTS
The patient survival rate was 99%, the incidence of perioperative stroke was 1%, and the incidence of aortic dissection was 1%. In the Port-Access mitral valve and atrial septal defect patients, the survival rate was 100% with no peri- or postoperative complications. Peri- and postoperative transesophageal echocardiography revealed no perivalvular leak or remaining mitral insufficiency after valve repair.


CONCLUSIONS
The EndoCPB endovascular cardiopulmonary bypass system allows the application of true Port-Access minimally invasive cardiac surgery in procedures that require the use of cardiopulmonary bypass and cardioplegic arrest. Sternotomy and its potential complications can be avoided, and the surgical procedures can be performed safely on an empty, arrested heart with adequate myocardial protection.
Reichenspurner
H
H
Department of Cardiac Surgery, Ludwig-Maximilians-University Munich, Germany.
Welz
A
A
Gulielmos
V
V
Boehm
D
D
Reichart
B
B
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000209:etiology; D001014:Aortic Aneurysm / Q000209:etiology; D006328:Cardiac Catheterization / Q000295:instrumentation; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D002561:Cerebrovascular Disorders / Q000209:etiology; D001026:Coronary Artery Bypass / Q000379:methods; D017548:Echocardiography, Transesophageal; D005260:Female; D006324:Heart Arrest, Induced; D006325:Heart Atria / Q000601:surgery; D006338:Heart Neoplasms / Q000601:surgery; D006344:Heart Septal Defects, Atrial / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D008943:Mitral Valve / Q000601:surgery; D008944:Mitral Valve Insufficiency / Q000209:etiology; D009232:Myxoma / Q000601:surgery; D012449:Safety; D013249:Sternum / Q000601:surgery; D015996:Survival Rate