Gareth Crouch

Minimally Invasive Mitral Valve Procedures: The Current State

Since its early days, cardiac surgery has typically involved large incisions with complete access to the heart and the great vessels. After the popularization of the minimally invasive techniques in general surgery, cardiac surgeons began to experiment with minimal access techniques in the early 1990s. Although the goals of minimally invasive cardiac surgery (MICS) are fairly well established as decreased pain, shorter hospital stay, accelerated recuperation, improved cosmesis, and cost effectiveness, a strict definition of minimally invasive cardiac surgery has been more elusive. Minimally invasive cardiac surgery started with mitral valve procedures and then gradually expanded towards other valve procedures, coronary artery bypass grafting, and various types of simple congenital heart procedures. In this paper, the authors attempt to focus on the evolution, techniques, results, and the future perspective of minimally invasive mitral valve surgery (MIMVS).

E-VITA Jotec Open Hybrid Stent Graft System for the Treatment of Complex Thoracic Aortic Aneurysm and Dissection—A Four Year Experience

INTRODUCTION The management of complex aortic aneurysms and dissections involving both the aortic arch and descending aorta include operations associated with significant risks of mortality and morbidity. The advent of hybrid systems such as the E-VITA Jotec open hybrid stent graft system (E-VITA) provides the advantage of single stage repair with follow up repair of any remaining downstream aneurysm and dissection being easier to manage. METHODS Herein we report a series of seven cases utilising E-VITA over a four year period. RESULTS The average patient age was 66.9 years of age (range: 55-78 years). The average cardiopulmonary bypass and circulatory arrest times were 237.14 min and 47.83 min. There was one operative mortality. Follow up as far as three years revealed good results with few complications. CONCLUSION The E-VITA is a feasible management option in the treatment of complex aortic aneurismal disease and dissections. It allows treatment of patients that may have previously not been considered suitable for two-stage surgical procedure.

Right video-assisted thoracoscopy thoracic duct ligation as treatment for a case of chyloptysis

CLINICAL SUMMARY A 71-year-old man presented with ongoing expectoration of milky, foul-tasting sputum, while denying any systemic symptoms. He first presented in 2007 with a type B dissection with an aneurysmal complex. He underwent distal aortic arch repair via a left anterolateral thoracotomy approach with femoral-femoral bypass via percutaneous cannulas. The distal aortic arch was transected and a 26-mm Dacron graft was sutured, with a distal anastomosis formed below the pulmonary hilum to the distal descending thoracic aorta. The left subclavian artery was resected as high as possible, anastomosed to an 18-mm Gelseal (Terumo Cardiovascular Systems Corp, Ann Arbor, Mich) graft that was then attached to the aortic graft. The patient was returned to the operating room postoperatively for evacuation of a hematoma, after which he progressed well and was transferred out of the intensive care unit. On day 14, a progressive left pleural effusion was confirmed on computed tomography and tapped using needle thoracostomy. Biochemistry of the specimen confirmed a diagnosis of chylothorax, with a protein level of 22 g/L, an LD level of 530 U/L, and a triglyceride level of 8.3 mmol/L, meeting the diagnostic criteria determined by the Mayo Clinic (>1.24 mmol/L or 110 mg/dL). After a trial of conservative therapy, including tube thoracostomy drainage and 2 weeks of a medium chaintriglyceride diet with octreotide adjunct, the chyle leak persisted and the patient received surgical intervention via redo thoracotomy.