Muhammad Asad Khan

Experience with a minimally invasive approach to combined valve surgery and coronary artery bypass grafting through bilateral thoracotomies.

BACKGROUND Minimally invasive coronary artery bypass grafting (MICS-CABG) and minimally invasive valve surgery (MIVS) have been used independently to manage occlusive coronary artery disease and valvular diseases, respectively. We present 12 patients who underwent combined MICS-CABG and MIVS via bilateral mini-thoracotomies. METHODS We retrospectively reviewed 116 consecutive valve/CABG operations by a single surgeon and compared the outcomes obtained via sternotomy with those obtained via bilateral minithoracotomies. RESULTS Six patients in the MIVS group underwent aortic valve replacement (sternotomy group, n = 70), 3 patients underwent mitral valve repair (sternotomy group, n = 9), and 3 underwent mitral valve replacement (sternotomy group, n = 25). The minimally invasive valve surgeries were combined with MICS-CABG for single- (n = 2), double- (n = 9), and triple-vessel (n = 1) coronary artery disease in a single operation. The mean SD duration of cardiopulmonary bypass was 164 ± 44.6 minutes (mean time via sternotomy, 152 ± 50.5 minutes; P = .4146), and the mean aortic cross-clamp time was 87.8 ± 22.1 minutes (mean time via sternotomy, 105 ± 39.8 minutes; P = .1455). The use of perioperative blood transfusions averaged to 2.3 ± 5.6 units (mean usage via sternotomy, 2.7 ± 4.9 units; P = .8326). There were no conversions to sternotomy in the minimally invasive group. Patients in the minimally invasive group were extubated earlier (24 ± 11 hours; sternotomy group, 40 ± 61 hours; P = .3684) and discharged earlier (7 ± 4 days) than patients who underwent median sternotomy (9 ± 10 days; P = .4027). CONCLUSION MICS-CABG combined with MIVS via bilateral minithoracotomies yielded short-term results comparable to those for CABG and valve repair via median sternotomy. There were no operative mortalities or reoperations. The possible advantages of the minimally invasive approach included earlier extubation and earlier discharge from the hospital. Combined CABG and valve surgery can be safely performed via bilateral thoracotomies.

A novel technique to remove inferior vena cava filters using a homemade snare device.

The need to retrieve inferior vena cava filters is quite evident due to the long-term complications. We present a novel technique to remove inferior vena cava filters using a homemade snare created using a looped a 0.014-inch semistiff wire. Employing this technique, 18 consecutive retrievable filters were removed. All filters were easily snared on the very first attempt, and no complications occurred. Our novel technique to retrieve filters is efficient, safe, and cost-effective.